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It is widely accepted that the uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. The aim of this study is to evaluate the anatomical relationship between the right vs. left CL and UTSL during robotic and laparoscopic utero-sacral ligament suspension (UTSLS) and its implication with the surgical technique during UTSL suspension. Material and Methods: We evaluated 25 women with apical pelvic organ prolapses of stages 2 - 4 and we analyzed 100 uterosacral and cardinal ligaments. They were assigned (non-randomly) to: a) robotic-assisted laparoscopic uterosacral ligament suspension (RAL-UTSLS), b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) or laparo-endoscopic single site utero-sacral ligament suspension (LESS-UTSLS). We evaluated the length (distance between origins and insertions) of the aforementioned ligaments using the Da Vinci Si and other laparoscopic instruments like calipers. Results: The mean length of the UTSL in their caudal-cranial extent was 3.5 ± 0.5 cm (right side) and 2.58 ± 0.3 cm (left side). Measurements were performed on the same way for the CL, resulting in 5.1 ± 0.3 cm (both side). The only significant difference was observed when comparing the right vs. left UTSL. This anatomic difference translates to 5 ± 1 suture stitches on the right UTSL vs. 2 ± 1 on the left UTSL. Conclusion: In our evaluation on cardinal and uterosacral ligament, the right UTSL was significantly longer as compared to the left and this allowed us to take 3 additional stitches on the right UTSL vs. left during RAL-UTSLS. Future studies are necessary to compare females with/without POP.

Anatomic Evaluation of Uterosacral and Cardinal Ligament during Robotic and Laparoscopic Surgery for Pelvic Organ Prolapse