Method of laparoscopic and robotic prevention of pelvic organ prolapse after hysterectomy

Objective. Evaluation of the results of simultaneous laparoscopic and robot-assisted pectopexy combined with hysterectomy in patients with apical pelvic organ prolapse (APOP). Materials and methods. A single-center observational prospective study that included patients who underwent minimally invasive hysterectomy in combination with POP correction in the period from 2023 to 2024. The criteria for inclusion in the study were the presence of grade I-IV apical POP according to the standardized classification Pelvic Organ Prolapse Quantification system (POP—Q), as well as the presence of diseases that serve as indications for hysterectomy. A total of 34 patients underwent surgery using this method during the follow-up period. The anatomical and functional results were evaluated 12 months after the intervention according to the POP-Q classification and internationally validated questionnaires. Results. Laparoscopic hysterectomy with simultaneous correction of apical POP took an average of 136±37 minutes. There was no recurrence of apical POP during the follow-up period, however, 3% (n=1) and 6% (n=2) of women had prolapse of the posterior and anterior vaginal walls, respectively. The patient satisfaction rate with surgical treatment was 97% (n=33). Conclusion. The technique of simultaneous fixation of the vaginal dome to the comb ligaments with obliteration of the Douglas space makes it possible to effectively surgically arrest apical POP in patients during hysterectomy, which makes it possible to surgically cover several gynecological diseases at once. This method is most justified in elderly women with overweight, burdened with somatic diseases, making it possible to reduce the risk of repeated interventions for POP.