Carter-Thomason Uterine Suspension and Positioning by Ligament Investment, Fixation and Truncation

Objective

To describe a technique and results of uterine suspension and positioning by extraperitoneal ligament investment, fixation and truncation (UPLIFT).

Study Design

Seventy-five women aged 19-48 years in a private referral center with chronic pelvic pain, dyspareunia and dysmenorrhea seeking treatment were evaluated and treated over a two-year period. Laparoscopic uterine suspension was performed using the Carter-Thomason 2-mm needle point suture passer. The instrument was passed within and along the round ligament. Thus, a pledget of round ligament and bridge of fascial tissue were created. Performing the uterine suspension procedure in this manner created shortened, thickened and strengthened ligaments that suspended the uterine fundus securely in a mildly anteverted position at the level of the exit point of the round ligaments through the inguinal canal.

Results

The procedure was performed without complications in 75 patients over a two-year span. Each patient was evaluated for degree of retroversion and was assessed by ultrasound to identify any uterine or ovarian abnormalities. Pelvic pain and dyspareunia were reproduced by palpation of the retroverted uterus. The procedure took an average of 12 minutes to perform. All procedures were performed as outpatient procedures with same-day discharge, and there were no intraoperative complications. Delayed postoperative pain at the suspension site significant enough to require oral analgesia or injection with local anesthesia occurred in five patients (7%), four for one week and one for one month. For all 75 patients the pain with menses decreased from 8.4 to 1.7, with 0 being no pain and 10 being the worst pain the patient had ever experienced (P<.01, Wilcoxon's Signed Rank Test). Pain with intercourse decreased from 8.1 to 1.5 (P<.01, Wilcoxon's Signed Rank Test). Sixty-three patients (84%) reported essentially no pain (0-2), while 5 (7%) reported mild pain (2-5), 3 (4%) reported moderate pain (5-7) and 4(5%) continued to have the pain that they had had before the surgery (8-10). For the 20 patients whom a retroverted uterus was the only significant pathologic finding, 18 of these (90%) had immediate and sustained relief from their symptoms.

Conclusion

When dyspareunia, dysmenorrhea and pelvic pain are associated with a retroverted uterus, the uterus can be repositioned to a slightly anteverted position by UPLIFT with the Carter-Thomason needle point suture passer. Results with anatomically correct technique are consistent with those previously give for other uterine suspension procedures. The advantages of this procedure are ease of performance, strengthening of the ligaments by shorting and the investment procedure, and a repair that maintains normal anatomic relationships.