Name of the Procedure:

Uterine Suspension, with or without Shortening of Round Ligaments, with or without Shortening of Sacrouterine Ligaments (Separate Procedure)

Summary:

Uterine suspension is a surgical procedure aimed at repositioning and securing the uterus in the pelvic cavity to address issues related to uterine prolapse. This may involve the shortening of the round ligaments and sacrouterine ligaments to provide additional support.

Purpose:

The procedure addresses uterine prolapse, a condition where the uterus descends into or outside of the vaginal canal due to weakened pelvic floor muscles and ligaments.

• Goals: To restore the uterus to its normal position, alleviate symptoms of prolapse (such as discomfort, urinary incontinence, and difficulty with bowel movements), and improve the patient's quality of life.

Indications:

• Symptoms of uterine prolapse such as pelvic pressure, vaginal bulging, and discomfort.
• Urinary incontinence or difficulty with bowel movements.
• Uterine prolapse diagnosed through pelvic examination or imaging.
• Patients for whom non-surgical treatments (like pelvic floor exercises or pessaries) are ineffective or inappropriate.

Preparation:

• Fasting for a certain period before the surgery.
• Adjusting or stopping certain medications as advised by the physician.
• Pre-operative diagnostic tests such as pelvic examination, ultrasound, and routine blood tests.
• Discussing medical history and any allergies with the healthcare team.

Procedure Description:

1. Anesthesia: The patient is typically given general or regional anesthesia.
2. Access: A surgical incision is made in the abdomen or vagina to access the pelvic cavity.
3. Suspension: The uterus is repositioned and secured using sutures. The round ligaments and sacrouterine ligaments may be shortened to provide additional support.
4. Closure: The incision is closed with sutures, and dressings are applied as necessary.

Tools: Surgical instruments such as scalpels, retractors, sutures, and possibly laparoscopic equipment if a minimally invasive approach is used.

Duration:

The procedure typically takes between 1 to 2 hours, depending on the complexity of the case.

Setting:

The procedure is usually performed in a hospital or a surgical center.

Personnel:

• Surgeon (typically a gynecologist or urogynecologist)
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications:

• Common risks: Infection, bleeding, pain.
• Rare risks: Damage to surrounding organs (bladder, bowel), blood clots, anesthesia-related complications.
• Management: Risks are mitigated through careful surgical technique and post-operative care. Complications are managed with appropriate medical or surgical intervention.

Benefits:

• Alleviation of symptoms related to uterine prolapse.
• Improved pelvic function, leading to better quality of life.
• The beneficial effects can typically be noticed within a few weeks post-surgery.

Recovery:

• Hospital stay for 1 to 2 days post-surgery.
• Instructions on wound care, activity restrictions, and medications.
• Avoid heavy lifting and strenuous activities for 6 to 8 weeks.
• Follow-up appointments to monitor healing and progress.

Alternatives:

• Non-surgical options like pessaries or pelvic floor exercises.
• Vaginal pessary: A device inserted into the vagina to support the uterus, suitable for mild cases or those not desiring surgery.
• Pros: Non-invasive, immediate relief.
• Cons: Requires regular maintenance and physician visits.

Patient Experience:

• During the procedure: Under anesthesia, the patient will not feel pain.
• After the procedure: Some discomfort and pain managed with medications.
• Post-operative instructions will include guidelines for gradually resuming normal activities and managing discomfort effectively.