(Video Poster 20) A Guide to Native-Tissue Hysteropexies

Objectives: The primary objective of this study is to demonstrate standard techniques for vaginal and abdominal native-tissue hysteropexy procedures. Further objectives include a review of the candidacy for hysteropexy, and clinical outcomes associated with hysteropexy compared to prolapse surgery with concurrent hysterectomy.

Methods: Hysteropexy procedures can be categorized as native-tissue versus graft-augmented hysteropexy, with vaginal or abdominal approaches. After a review of the comparative data of hysteropexy to hysterectomy-based prolapse surgery, this video reviews the surgical technique for native-tissue hysteropexy of the vaginal approach and abdominal approach. Sacrospinous ligament hysteropexy can be performed with 3 approaches to the sacrospinous ligament via the anterior, apical or posterior compartment. The vaginal uterosacral ligament hysteropexy begins by accessing the Pouch of Douglas through a posterior colpotomy and placement of delayed absorbable sutures into the uterosacral ligament. The abdominal approach to uterosacral ligament suspension is demonstrated both on laparoscopic and robotic-assisted laparoscopic techniques. This video also includes surgical tips on various methods to anchor the apical sutures into the cervix. In our practice, those with a Stage 2 apical compartment prolapse are excellent candidates for uterosacral ligament hysteropexy while those with Stage 3 cystocele or rectocele are excellent candidates for sacrospinous ligament suspension.

Clinical Relevance: Hysteropexy is increasing in popularity in recent years. It challenges the traditional belief that hysterectomy is necessary as part of prolapse repair. The 2025 American Urogynecologic Society Clinical Practice Statement states that “In the absence of previous or current uterine or cervical pathology, all patients with a uterus should be offered uterine preserving prolapse surgery”. Ongoing research into this field shows that patients do place value on the uterus beyond its function of reproduction, and that if given the choice, more patients would choose to preserve their uterus. Dedicated training into the various hysteropexy procedures is necessary to ensure that all patients have access to both hysterectomy-based and hysteropexy prolapse procedures.