Uterine Prolapse Repair Using the ELEVEST^® Procedure

Uterine prolapse is a major health concern affecting over 3 million women between the ages of 30-59 years. Approximately 11% of all women will undergo some type of surgical procedure during their lifetime to correct or repair prolapsed pelvic organs. ¹ Uterine prolapse was the third most frequent cause of hysterectomy in the U.S. from 1988-1993 accounting for 548,657 procedures. ² Women who suffer from this condition have symptoms that impact their quality of life. But often they do not seek help due to embarrassment. The following case presents the application of a new technique to repair uterine prolapse and restore the uterus to its normal anatomical position using the patients' own support structures.

A 35-year-old woman, para 2, gravida 2 with pregnancies 2 years apart, experienced a prolapsed uterus after her first delivery. The patient went on to conceive and deliver a second child without event. However, she presented to our practice approximately 5 weeks after delivering the second child with a total uterine prolapse. The prolapse was classified as a grade IV, according to the POP-Q classification with the cervix protruding through the introitus. The patient also complained of swelling in both legs, dyspareunia and extreme fatigue.

A new technique called the ELEVEST procedure was performed to repair the prolapse. To correct for the degree of retroversion created by the prolapse, the uterus was supported by shortening and fixing the round ligaments. The uterosacral ligaments were then identified. Three sutures were placed in each of the ligaments. The first was in the posterior third of the ligament, the second at the midpoint, and the third within 1 cm of the cervix. The ends of the suture material were pulled through the lateral trocar ports and tied extracorporeally to shorten the uterosacral ligament and pull it closer to the midline. This technique was then performed on the opposite side.

The total operating time was 1.5 hours. The entire procedure was done laparoscopically using the ELEVEST procedure kit (Inlet Medical, Inc. Eden Prairie, MN). The patient was discharged the same day with mild analgesics and resumed normal activity within 4 days.

The patient was seen again at 4 months and had a complaint of mild right-side discomfort. As of last follow-up at 11 months, the patient had no complaints. Physical examination showed the uterus in its normal anteverted position with no descensus detected.

Conclusion

The ELEVEST procedure is a straightforward simple approach to laparoscopic uterine prolapse repair. Early results look very promising and further clinical study is ongoing.

References

1. Olson AL, Smith VJ, Bergstrom JO, Colling JC et al. Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Obstetric Gynecology 1997;89:501-506.
   
   
2. CDC Morbidity and Mortality Weekly Report, Special Focus: Surveillance for Reproductive Health 1997;46(Suppl. 4):1-47.