Laparoscopic Approach for Shull Repair of Pelvic Floor Defects

Study Objective: To prove the feasibility of the Shull technique by a laparoscopic approach in a patient affected by pelvic organ prolapse (POP) with apical loss of support. Design: A step-by-step video demonstration (Canadian Task Force classification III). Setting: University hospital. Ethics Committee ruled that approval was not required for this study. Patient: A 53-year-old woman with a POP-Q stage IV, left ovarian cyst. Intervention: Laparoscopic uterosacral ligament suspension. Measurements and Main Results: According to the National Health and Nutrition Examination Survey, approximately 3% of women in the United States report symptoms linked to POP, with approximately 300 000 POP surgeries each year in the United States. More recent studies show a lower reoperation rate of approximately 6% to 30%, and this lower reoperation rate may reflect improvement in surgical technique and POP surgery that includes suspension of the vaginal apex, which is associated with a decreased reoperation rate, commonly done by vaginal vault suspension to uterosacral ligaments. Suturing the apex to the high (proximal) portion of each uterosacral ligament is more commonly performed vaginally, although abdominal and laparoscopic approaches are suitable. It represents a modification of the uterosacral ligament suspension procedure described by Shull. A 53-year-old woman with a POP-Q stage IV, left ovarian cyst and an "elongatio colli" underwent a total hysterectomy and bilateral ovariectomy with vaginal dome uterosacral ligament suspension performed laparoscopically. The total operating time was 80 minutes, with a blood loss volume of less than 50 mL. The patient was hospitalized for 2 days. There were no postoperative complications in 30 days. Conclusion: The Shull laparoscopic surgery for advance POP with reconstruction of the anterior compartment is technically feasible.