Uterosacral ligament suspension sutures: Anatomic relationships in unembalmed female cadavers

• Published in: American journal of obstetrics and gynecology Vol. 197; no. 6; pp. 672.e1 - 672.e6
• Main Authors: Wieslander, Cecilia K., MD, Roshanravan, Shayzreen M., MD, Wai, Clifford Y., MD, Schaffer, Joseph I., MD, Corton, Marlene M., MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.12.2007; Elsevier
• Subjects: Aged; Aged, 80 and over; anatomy; Biological and medical sciences; Blood Vessels - injuries; Cadaver; Female; Gynecologic Surgical Procedures - adverse effects; Gynecology. Andrology. Obstetrics; Humans; Ligaments - surgery; Lumbosacral Plexus - injuries; Medical sciences; nerve injury; Obstetrics and Gynecology; rectal injury; Rectum - anatomy & histology; Rectum - injuries; Sacrococcygeal Region - blood supply; Sacrococcygeal Region - innervation; Suture Techniques; Ureter - anatomy & histology; Ureter - injuries; ureteral injury; uterosacral ligament; Uterus - surgery; rectal injury; uterosacral ligament; anatomy; nerve injury; ureteral injury; Uterosacral ligament; Gynecology; Female; Suspension; Anatomy; Obstetrics; Cadaver; Suture
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2007.08.065

Objective The objective of the study was to characterize anatomic relationships of uterosacral ligament suspension (USLS) sutures. Study Design The relationship of USLS sutures to the ureters, rectal lumen, and sidewall neurovascular structures was examined in 15 unembalmed female cadavers. Results The mean distance of the proximal sutures to the ureters and rectal lumen was 14 mm (range, 0-33) and 10 mm (range, 0-33), respectively. The mean distance of the distal sutures to the ureters was 14 mm (range, 4-33) and to the rectal lumen 13 mm (range, 3-23). Right sutures were noted at the level of S1 in 37.5%, S2 in 37.5%, and S3 in 25% of specimens. Left sutures were noted at the level of S1 in 50%, S2 in 29.2%, and S3 in 20.8% of cadavers. Of 48 sutures passed, 1 entrapped the S3 nerve. Sutures perforated the pelvic sidewall vessels in 4.1% of specimens. Conclusion USLS sutures can directly injure the ureters, rectum, and neurovascular structures in the pelvic walls.