Modified Laparoscopic Uterosacral Ligament Suspension in Patients with Gynecologic Tumors and Advanced Uterovaginal Prolapse

Objectives: To evaluate the feasibility and safety of a novel approach for concomitant endoscopic treatment of gynecologic tumors and advanced uterovaginal prolapse. Methods: Prospective pilot study with women affected by gynecologic tumors synchronically with uterovaginal prolapse. Patients underwent laparoscopy for the oncologic treatment in parallel with uterosacral ligament suspension (USLS) and culdoplasty. Patients were assessed in regard to (1) feasibility and safety and (2) objective and subjective efficacy of the combined procedure. Results: Six women were endoscopically operated without conversion. The USLS/culdoplasty procedure accounted for 16% of the total operative time. Average operative time, blood loss and length of hospitalization were favorable. No major complications were observed during and after the surgeries. The mean follow-up was 20.3 months. Postoperative POP-Q measurements showed important improvements in the anterior and apical vaginal compartments and all patients were cancer free at the latest follow-up visit. Conclusion: Gynecologic tumors associated with advanced uterovaginal prolapse may be successfully treated by one-stage laparoscopic operation.