In a perfect world, a woman's uterus and cervix sit snugly above the vagina, supported by the uterosacral ligaments. Should childbirth or the natural aging process cause these uterosacral ligaments to weaken, the uterus and cervix may drop down into the vaginal canal. For generations, gynecologists have considered hysterectomy, the removal of the uterus and cervix, to be the best way to treat uterine prolapse. More recently, studies in Europe and North America have revived the option of uterine resuspension, aka hysteropexy, as an equivalent, if not superior, alternative to hysterectomy for uterine prolapse. Yes, I said revived. All of these new millenium uterine resuspension operations owe a debt of gratitude to the radical, 19th century prototype prolapse operation called the Manchester procedure. The Manchester procedure was first introduced in 1888, designed to restore uterine support to young, unmarried women toiling in the local sheepshearing industry. Frequent lifting of sheep tended to strain those uterosacral ligaments, causing the uterus to drop in many of these women, making marriage, conception and childbirth difficult. The Manchester procedure preserved fertility by correcting prolapse without removing the uterus and ovaries, every woman's organs of procreation. The Manchester has two steps ' First, the uterus is resuspended to the Cardinal ligaments that form the vaginal portion of the uterosacral ligaments, by wrapping one from each side in front of the cervix. Then the cervix is shortened so that it cannot be seen or felt at the vaginal opening. Cervical shortening is only necessary for women with prolapse who suffer abnormal elongation of the cervix, a condition called cervical hypertrophy. The exact prevalence of cervical hypertrophy is not known. Conservatively, probably 10-20% of prolapse patients also have a very long cervix. When necessary, cervical shortening is best done in a fashion that leaves a normal 3-4 cm cervical length. Unfortunately, it can be difficult to find a surgeon to perform this or any other uterine resuspension procedure, because most doctors today prefer hysterectomy for prolapse surgery, even though hysterectomy does nothing to improve the integrity or durability of prolapse repair. Today, the Manchester survives as a viable option for advanced elderly, sedentary women who need a quick, minimally invasive prolapse operation. If you think that uterine resuspension might be right for you, or if you're interested in alternative options to treat prolapse, check out other videos in this series.