Carter-Thomason uterine suspension and positioning by ligament investment,fixation and truncation

OBJECTIVE: To describe it technique and results of uterine suspension and p ositioning by extraperitoneal ligament investment,fixation and truncation ( UPLIFT). STUDY DESIGN: Seventy-five women aged 19-48 years in a private referral cen ter with chronic pelvic pain, dyspareunia and dysmenorhea seeking treatment were evaluated and treated over a two-year period. Laparoscopic uterine su spension was performed using the Carter-Thomason 2-mm needle point suture p asser. The instrument was passed within and along the round ligament. Thus, a pledget of round ligament and bridge of fascial tissue were created. Per forming the uterine suspension procedure in this manner created shortened, thickened and strengthened ligaments that suspended uterine fundus securely in a mildly anteverted position at the level of the exit point of the roun d ligaments through the inguinal canal. RESULTS: The procedure was performed without complications was evaluated fo r degree of retroversion and was assessed by ultrasound to identify any ute rine or ovarian duced 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 intraoper ative complications. Delayed postoperative pain at the suspension site sign ificant enough to require oral analgesia or injection with local anesthesia occurred in five patients (7%), four for one week and one for one month. F or all 75 patients the pain with menses decreased from 8.4 to 1.7, with 0 b eing 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 pa in that they had had before the surgery (8-10). For the 20 patients for who m a retroverted uterus was the only significant pathologic finding 18 of th ese (90%) had immediate and sustained relief from their symptoms. CONCLUSION: When dyspareunia, dysmenorrhea and pelvic pain are associated w ith a retroverted uterus, the uterus can be repositioned to a slightly ante verted position by UPLIFT with the Carter-Thomason needle point suture pass er. Results with this anatomically correct technique are consistent with th ose previously given for other uterine suspension procedures. The advantage s of this procedure are ease of performance, strengthening of the ligaments by shortening and the investment procedure, and a repair that maintains no rmal anatomic relationships.