Sacrospinous Hysteropexy Surgical Procedure

The surgical procedure of SSH performed at our institution is conducted as follows: high posterior colpotomy is made towards the posterior cervix, then blunt preparation towards the right ischial spine to visualize the right sacrospinous ligament. The posterior side of the cervix is joined to the right sacrospinous ligament with two late-absorbable sutures (PDS sutures–0) at least 2 cm medial to the ischial spine. This suture is then passed through the posterior cervical wall, but not yet knotted. First, the colpotomy is closed via absorbable sutures (2/0 vicryl, Ethicon, Sommerville, NJ, USA). Where additional procedures such as anterior and/or posterior colporrhaphy were needed, they were performed at this stage. Only after are the pre-laid fixation sutures tied, whereby the cervix comes to lie about 4–6 cm cranial of the level off the vulva towards the sacrospinous ligament, without the cervix abutting the sacrospinous ligament, but so that the knot on the side of the ligament slips off slightly, in order to avoid the occurrence of necrosis or the cutting of the thread into the ligament. It, thus, follows closely the surgical procedure of SSH previously described by Schulten et al., however, in contrast, no surgical devices were used [16 (link)].