Pelvic Denervation and Uterine Suspension: Techniques for Treating Chronic Pelvic Pain

Uterine suspension was first described in the medical literature in 1882. Variations in technique followed in subsequent decades. During that time, uterine suspension was frequently performed for a variety of general constitutional disturbances and local functional disorders. Because of issues regarding benefits and durability, the procedure largely fell out of favor.

The ability to perform uterine suspension laparoscopically has led to a rebirth of the approach. However, methods that rely on the strength of a substantial portion of the round ligament have not proven any more durable than the early laparotomy versions: over time – often only a short time – retroversion has recurred.

The UPLIFT procedure, a more recent laparoscopic innovation, uses permanent suture delivered through a suture passer developed specially for this purpose (Metra PS^® procedure kit). The suspension is dependent almost entirely on the strength of the suture itself and only minimally relies on the medial-most 1 cm of the round ligament.

Initial clinical reports suggest that this method of uterine suspension may be an improvement on earlier techniques by virtue of its greater durability, i.e. long-term success. In approximately 40 cases, only 2 recurrences have occurred during the first 2 postoperative years. In only 1 case has removal of the sutures been necessary due to persistent discomfort at the site of the knot.

Outcomes measurement is confounded by the frequency of concomitant pelvic pathology, which also may be treated at the same time uterine suspension is preformed. However, early reports of surgeries involving only suspension are encouraging.