58410 Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; with presacral sympathectomy

Name of the Procedure:

Uterine Suspension with Presacral Sympathectomy (with or without Shortening of Round Ligaments, with or without Shortening of Sacrouterine Ligaments)

Summary

Uterine suspension with presacral sympathectomy is a surgical procedure where the uterus is repositioned and anchored within the pelvic cavity. This may involve shortening the round ligaments and sacrouterine ligaments. Additionally, a presacral sympathectomy, which involves cutting nerves located in the presacral area, is performed to alleviate certain symptoms.

Purpose

This procedure is primarily used to address uterine prolapse, where the uterus descends from its normal position into the vaginal canal. The goals are to restore normal pelvic anatomy, alleviate symptoms such as pelvic pain or pressure, and improve the patient's quality of life.

Indications

• Uterine prolapse causing discomfort or interference with daily activities
• Chronic pelvic pain associated with uterine prolapse
• Dysfunctional uterine bleeding not responsive to medical treatment
• Pelvic floor weakness or damage

Preparation

• Patients might be required to fast for at least 8 hours before the surgery.
• Pre-operative blood tests and imaging studies such as pelvic ultrasound may be necessary.
• Discuss any medications with your doctor; some may need to be adjusted or temporarily discontinued.
• Pre-surgery bowel preparation may be required.

Procedure Description

1. The patient is given general anesthesia for comfort.
2. An incision is made in the lower abdomen.
3. The surgeon repositions the uterus and shortens the round and/or sacrouterine ligaments if needed.
4. In the presacral sympathectomy, nerves in the presacral area are identified and severed to reduce pain.
5. The uterus is anchored in its new position using sutures.
6. The incision is closed, and the area is bandaged.

Tools & Equipment: Surgical drapes, scalpels, sutures, laparoscopic instruments (if using a minimally invasive approach).

Duration

Typically, the procedure takes about 2 to 3 hours.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Gynecologic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (bladder, intestines)
• Anesthesia-related risks
• Blood clots
• Nerve damage leading to chronic pain

Benefits

• Relief from symptoms of uterine prolapse and pelvic pain.
• Improved quality of life with restored pelvic anatomy.
• Long-term stabilization of the uterus.

Recovery

• Hospital stay may last 1-2 days.
• Patients are advised to avoid heavy lifting and strenuous activity for 4-6 weeks.
• Follow-up appointments to monitor healing and progress.
• Pain management with prescribed medications.

Alternatives

• Pessary (a device inserted into the vagina to support the uterus)
• Pelvic floor physical therapy
• Hysterectomy (removal of the uterus)
• Lifestyle changes and exercises to strengthen pelvic floor muscles

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel pain. Post-surgery, there may be discomfort and pain managed with medications. Gradual return to regular activities is expected, with complete recovery typically in 4-6 weeks. Patients may need to adapt to new daily routines and follow specific post-operative care instructions to ensure proper healing.