ABSTRACT

Objective:

The aim of this study was to assess the surgical feasibility, safety and clinical/anatomical outcomes of vaginal vault suspension applying a new method at the time of laparoscopic hysterectomy. This technique was based on the theory that the use of the obliterated umbilical artery as an anchoring structure provides a safe, anatomically correct and flexible suspension to the vaginal cuff.

Methods:

Twentyfive patients during an 8-month period with a benign disease, in two cases with coexisting pelvic floor disorder, underwent total laparoscopic hysterectomy completed by a bilateral suspension of the vaginal vault to the proximal segment of the obliterated umbilical artery (chorda). Patients were examined at 6 weeks after the operation with site-specific analysis of vaginal cuff anatomy and interviewed by a questoinnaire focusing on pre- and postoperative complaints. The overall follow-up lasted 8 months.

Results:

There were no intra- and postoperative complications. Six weeks after the operation all patients were without complaints. The length, the position and the axis of the vaginal cuff was found to be excellent in all cases, yet, the fixed vaginal cuff was found to be flexible. In the two cases when surgery was performed for patients with moderate apical prolapse no prolapse of the vaginal vault could be detected at six weeks and in one case 5 month following the operation.

Conclusion:

Vaginal vault suspension through the chorda of the umbilical artery is easily performed via laparoscope and is associated with excellent clinical and anatomical outcomes in short-term follow-up.