Sacrospinous cervicopexy

Prolapse of the uterus in a young woman desirous of conserving the uterus is a difficult situation to manage, if the existing supports of the uterus are weak. Three effective operations for this purpose are Purandare’s cervicopexy, Shirodkar’s sling operation, and Khanna’s sling operation. All of these are abdominal oprations. A new operation is described, to be performed by the vaginal route.

1. The patient is placed in lithotomy position.
2. The sacrospinous ligament of one side is exposed by making a longitudinal incision in the posterior vagina in midline, and dissecting the rectum backwards.
3. The posterior peritoneal pouch is opened to expose the upper surface of the uterosacral ligaments.
4. A helical stitch of No. 1 polyamide or polypropylene is passed through both of the uterosacral ligaments 1 cm from their uterine attachments. Five knots are tied.
5. One end of the suture is passed through the exposed sacrospinous ligament, 1 cm from the ischial spine, using a special needle (as in sacrospinous vault suspension) or a mixter.
6. The posterior peritoneal opening is closed with a purse-string suture of No. 1-0 chromic catgut or polyglactin 910 suture.
7. The two ends of the uterosacral suture are tied to each other, so that the cervix gets suspended from the sacrospinous ligament.