Olshausen suspension

Olshausen suspension

In the past, suspension of the uterus in retroverted position was a common operation. Although it is rarely used today as a definitive procedure, it still has a recognized place in gynecological surgery, particularly when the operation is performed in conjunction with other procedures designed to improve fertility. It is important that the uterus be suspended in such fashion that it will not break down under the stress of the enlarging fetus and that it not interfere with a successful delivery.

The Olshausen type of suspension has fulfilled these obligations over a long period of time and has the advantage of being a simple operative procedure.

Figure 1. The abdomen has been opened through a paramedian incision in the usual manner. The surgeon grasps the uterus with thumb and forefinger and draws the uterus up out of the pelvis to the position on the anterior abdominal wall where it lies without undue tension. This is important.

The assistant maintains the position of the uterus as the surgeon picks up the round ligament about V2 inch lateral to its point of insertion in the uterine wall. If placed too far out on the round ligament, an opening may be left to the lateral side through which small bowel might herniate.

The surgeon then places a cutting point stitch at this point, carrying two strands of heavy braided silk beneath the round ligament.

Figure 2. Kelly clamps are placed on the edge of the peritoneum and the anterior rectus fascia at the level selected for fixation. The assistant holds back the subcutaneous fat and skin with a retractor. The surgeon exposes the undersurface of the peritoneum by elevating the two Kelly clamps in the left hand while he introduces the stitch into the peritoneum, muscle and fascia.

Figure 3. The clamps are then drawn firmly to the midline, thus exposing the point of exit of the suture on the anterior rectus sheath.

Olshausen suspension

Olshausen suspension

Figure 4. The surgeon maintains traction on the left rectus fascia and peritoneum toward the midline while he returns the suture again through the fascia muscle and peritoneum. The point of exit on the peritoneal side should be approximately V2 inch from the point of the initial introduction. This suture is thus a mattress suture passing through all the structures noted.

Olshausen suspension

Figure 5. The peritoneum and fascia are again elevated to the left by the Kelly clamps held in the left hand of the surgeon. The area of peritoneum between the two double strands of silk is then scarified with a knife blade.

Figure 6. The double strands of silk are drawn taut, pulling the round ligament and with it the uterus up to the scarified area on the abdominal wall. The process is repeated on the opposite side.

Figure 7. This shows the round ligament in relation to the abdominal wall after the suture has been tied.

Peritoneum

Scarified area

 Essential Surgical Practice 

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