Before the 20th century, most treatments were partial or had serious drawbacks. Cruikshank SH, Muniz M: Outcomes study— sacrospinous fixations over a year period, a study of the cure rates. The sutures are attached so that when tied, the uterosacral-cardinal ligaments are drawn toward the midline, thereby helping to close off the cul-de-sac.
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McCall Culdoplasty during Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial.
If the indication for hysterectomy includes uterovaginal prolapse, these ligaments must be shortened to eliminate any laxity that is present. These steps are completed during any transvaginal hysterectomy. Superior view of the cul-de-sac of Douglas.
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The following steps can be performed at the beginning or the end of the procedure. It also accomplishes high peritoneal ligation, which is an important step in closing a deep cul-de-sac. Sacral colpopexy with dura mater graft. Etiologic factors include trauma, menopausal atrophy and attenuation, total vaginal hysterectomy mccalls, possibly, pudendal neuropathy, with loss of levator and endopelvic fascia integrity. Role of the uterosacral-cardinal ligament in protecting the ureter during transvaginal hysterectomy.
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