Laparoscopic Sacrohysteropexy: Uterine Preservation in Treatment of Apical Prolapse

INTRODUCTION: Laparoscopic sacrohysteropexy is a uterine-conserving surgical technique for the treatment of apical prolapse. Uterine-conserving prolapse management has been shown to improve operating time, blood loss, and risk of mesh exposure. Further benefits include higher apical suspension, increased total vaginal length, and lower risk of apical re-operation. OBJECTIVE: The objectives of this video are to highlight the benefits of a uterine-preserving technique to manage apical prolapse, review the preoperative evaluation to determine patient candidacy, and demonstrate the steps of laparoscopic sacrohysteropexy in two patients with apical prolapse. METHODS: Educational video demonstrating a technique for laparoscopic sacrohysteropexy on two patient cases. RESULTS: We demonstrate our approach to laparoscopic sacrohysteropexy for the management of apical prolapse. Our first case was a 71-year-old female with a history of two prior vaginal deliveries and symptomatic pelvic organ prolapse who desired uterine preservation. Our second case was a 67-year-old female who presented with a history of stage 3 apical and anterior wall prolapse. We highlighted key steps, including retroperitoneal dissection at the sacral promontory, creation of a bladder flap, use of a braided polyester fiber suture to anchor the uterus, and retroperitonealization of the braided suture. We demonstrated resolution of apical and anterior prolapse on physical exam postoperatively. CONCLUSIONS: We have demonstrated the effectiveness of a laparoscopic sacrohysteropexy for uterine-conserving treatment of apical prolapse in two patients, highlighting nuances of varied anatomy in conducting this procedure.