LAPAROSCOPIC UTERINE SUSPENSION (HYSTEROPEXY)
What is a laparoscopic hysteropexy?
Hysteropexy is resuspension of the prolapsed uterus using a strip of synthetic mesh to lift the uterus and hold it in place. The operation is performed using keyhole surgery (laparoscopy).
When is a laparoscopic hysteropexy performed?
A hysteropexy is performed to correct prolapse of the uterus (womb).
Most gynaecology units in the UK would offer hysterectomy when the uterus has prolapsed. This is inappropriate when women wish to preserve fertility and indeed many women who have completed their families still wish to preserve their uterus.
Laparoscopic resuspension and preservation of the uterus as an alternative to hysterectomy is not widely available. Oxford is one of few centres offering this surgery and it is important patients appreciate it is still a relatively new procedure with no long term follow up results. We have however in Oxford been offering this operation since 2004 and have treated over 700 women this way and have published our results.
The theoretical advantages of this operation over hysterectomy, as well as preservation of fertility, are a stronger repair, with less risk of recurrent prolapse. Cuts to the vagina itself are also avoided so it is likely there is less risk of subsequent sexual problems.
The decision to perform a laparoscopic hysteropexy is made only after a thorough discussion with the patient. The choice of treatment depends on the nature and extent of the prolapse, as well as patients personal factors.
What does the operation involve?
The procedure is performed under a general anaesthetic through keyhole incisions. One end of the mesh is attached to the cervix and the other to a ligament over the back bone (sacrum) near the spine. This gently lifts the uterus back up into its normal anatomical position.
If the patient has a prolapse affecting the front or the back of the vagina, the surgeon may suggest repairing this at the same time. This additional surgery is called an anterior or a posterior repair.
The benefits of laparoscopic hysteropexy
- keyhole (minimally invasive) procedure
- more than 95% cure rate for uterine support
- 1-2 tablespoons average blood loss
- short hospital stay
What is recovery after surgery like?
Most women stay in hospital for 24-48 hours after surgery. Usually, on the first morning after the operation the catheter is removed and the patient is able to eat, drink and move around. Recovery after surgery varies between individuals. Most women will resume driving and work within 2-4 weeks. The body will be using extra energy to build new cells and repair itself and patients may therefore feel tired for 4-6 weeks after surgery.
For more information about recovering from the operation, and what to expect on going home, read our information leaflet: Laparoscopic hysteropexy
- Royal College of Obstetricians and Gynaecologists
- British Society of Urogynaecology
- International Urogynaecology Association
- Helen Jefferis, Natalia Price & Simon Jackson.
Laparoscopic hysteropexy: 10 years' experience. Int Urogynecol. J, DOI 10.1007 s00192-016-3257-4
- Rahmanou P, White B, Price N, Jackson S.
Laparoscopic Hysteropexy: one to four years follow up of women post operation. Int Urogynecol J. 2013 Nov 6.
- Price N, Slack A, Jackson S.
Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 2010;117:62-68