Dacatra

Primary Pelvic Floor Repair with Laparoscopic Supracervical Hysterectomy

Laparoscopic Supracervical Hysterectomy (LSH) is a common advanced laparoscopic procedure offered as
treatment for a number of gynecologic problems. Ideas vary among surgeons regarding optimal closing
techniques of the cervix and pelvic floor. Many advocate no closure at all. Another consideration
with LSH is adjunctive treatment of uterine prolapse either identified preoperatively, or noted with
hypermobility in the post-LSH cervix at surgery.
In this video, I am demonstrating a technique for primary cervix and pelvic floor closure. In
addition, I show a simple technique of uterosacral reattachment or plication for support of the
residual post-LSH cervix and vaginal vault. This can be done with or without robotic technique. It
can be done with total hysterectomy as well. This video uses the daVinci-S robotic technology with
the advantages of improved instrument dexterity and visualization. I use sharp dissection and
intermittent pulsed radio-surgical desiccation.
The purpose primary pelvic floor repair and uterosacral plication is to enhance apical pelvic floor
support, increase or maintain vaginal length and provide peritoneal closure for reduced adhesions.
After over 150 cases, my experience has been very favorable outcomes and no major complications. A
few patients have been evaluated with repeat laparoscopic procedures by the author and no significant
adhesions have been noted. Favorable post-op objective and subjective findings regarding pain,
bladder, bowel and sexual function are comparable to other laparoscopic procedures. Uterosacral
plication or reattachment adds a measurable improvement in post LSH vaginal length and apical
support. Most importantly, patient satisfaction scores are high with this procedure.