From the Guidelines
No, sacrospinous fixation is not typically part of a laparoscopic hysterectomy procedure. These are two distinct gynecological procedures with different purposes. Laparoscopic hysterectomy is a minimally invasive surgical technique to remove the uterus through small abdominal incisions using a laparoscope. In contrast, sacrospinous fixation is a procedure specifically designed to treat pelvic organ prolapse by attaching the vaginal vault or cervix to the sacrospinous ligament to provide support and prevent prolapse, as mentioned in the context of anti-incontinence and pelvic reconstructive surgeries 1. While both procedures may sometimes be performed during the same surgical session in patients who have both indications (such as a patient requiring hysterectomy who also has prolapse concerns), sacrospinous fixation is a separate procedure with its own surgical steps, techniques, and equipment. Some key points to consider include:
- Sacrospinous fixation is typically performed vaginally rather than laparoscopically, though some surgeons may use laparoscopic approaches for certain pelvic floor repairs.
- The decision to perform sacrospinous fixation during a hysterectomy would depend on the patient's specific needs and risk factors for prolapse.
- The use of sacrospinous fixation as part of a larger surgical plan would be determined on a case-by-case basis, considering the patient's overall health, the extent of the prolapse, and other factors that might influence the choice of procedure, as guided by principles outlined in studies like 1.
From the Research
Sacrospinous Fixation in Laparoscopic Hysterectomy
- Sacrospinous fixation is a surgical technique used to treat pelvic organ prolapse, but its relation to laparoscopic hysterectomy is not directly addressed in the provided studies.
- However, studies have compared sacrospinous hysteropexy with vaginal hysterectomy with uterosacral ligament suspension 2, 3 and modified laparoscopic uterine suspension with vaginal hysterectomy with sacrospinous ligament fixation 4.
- These studies suggest that sacrospinous hysteropexy and modified laparoscopic uterine suspension are alternative procedures to vaginal hysterectomy with uterosacral ligament suspension or sacrospinous ligament fixation, but they do not indicate that sacrospinous fixation is a part of the laparoscopic hysterectomy procedure.
- One study mentions transvaginal sacrospinous ligament fixation as a technique for posthysterectomy vaginal vault prolapse repair 5, which implies that sacrospinous fixation can be performed after a hysterectomy, but it does not specify if it is part of a laparoscopic hysterectomy procedure.
Key Findings
- Sacrospinous hysteropexy with graft resulted in a lower composite failure rate than vaginal hysterectomy with uterosacral ligament suspension 2.
- Modified laparoscopic uterine suspension had similar postoperative outcomes and anatomical results to vaginal hysterectomy with sacrospinous ligament fixation, but with fewer postoperative complications 4.
- Sacrospinous hysteropexy had a higher proportion of women with a composite outcome of success compared to vaginal hysterectomy with uterosacral ligament suspension 3.
- Transvaginal sacrospinous ligament fixation is a safe and effective technique for apical support without the use of prosthetic materials 5.