Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

Sir, I read with interest the article by Cutner et al. proposing a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation.1 I am grateful to the authors for resurrecting a similar operation described by Shirodkar in 1958.2,3 A subsequent article by Dastur et al.4 in 1967 described about 100 procedures performed using the same technique as described by Shirodkar. In both these articles, the authors have commented on the risk of erosion of the Mersilene tape into the sigmoid colon if the tape was placed along the left uterosacral ligament as described by Cutner et al. They therefore used a short length of Mersilene tape to form a loop around the left psoas muscle and passed the left Mersilene tape through this loop to reduce the risk of erosion. I had my initial training in Mumbai in India and had the good fortune to witness several operations as described by Shirodkar. In 1992, Rane has written a letter to the editor of BJOG about a modified approach, wherein he inserted a tape only on the right side with a view to avoiding colonic compression or distortion.5 I agree with the authors that a laparoscopic approach affords a brilliant view and a quick postoperative recovery, and I wish to congratulate the authors for this novel technique. I would however urge them to consider inserting a psoas loop. j