Laparoscopic Treatment of Uterine Prolapse and Relaxation

A new technique was developed for treating patients with uterine prolapse and relaxation by means of laparoscopy with special tools. The assistant transposes the uterus with a special vaginal probe to remove the descensus. This position is fixed with the help of laparoscope, brought to the new position of the uterus. With laparoscopic lighting, this point is seen at the front abdominal wall. A cutaneous section (2-3 cm) up to the aponeurosis is made under this point. A puncture with a special needle with a hole for suture is made through the section and uterine fundus under laparoscopic control. The suture is taken from the needle by a forceps introduced through the operating laparoscope cannula. The needle then is removed from the abdomen and another puncture is made 1 to 1.5 cm from the first puncture under laparoscopic control (the laparoscope remains in the abdomen until the procedure is completed). The uterus is punctured with the empty needle 1 to 1.5 cm from the puncture and the suture is taken out. The suture left after the first puncture is pulled by the forceps, loaded into the empty needle, and led through the uterine fundus. Then the needle with the suture is placed in the incision in the abdomen wall. The uterus is pulled up to the required position with the two sutures under laparoscopic control and the suture is tied. The uterus is now fixed to the aponeurosis. The incision in the abdomen is sewed with one or two sutures or subcutaneously. The operation lasts 7 to 10 minutes. Since January 1994, 34 procedures were performed. Prolapse recurred in one woman. Patients with evident uterine prolapse and relaxation first underwent anterior and posterior colporrhaphy and then laparoscopic fixation of the uterus.