(Video Poster 14) Robotic-Assisted Laparoscopic Cerclage Sacrohysteropexy for Uterine Prolapse

Objectives: The goal of this video is to demonstrate the robotic-assisted approach in performing laparoscopic synthetic mesh cerclage hysteropexy for treatment of uterovaginal prolapse.

Methods: A robotic-assisted laparoscopic approach was taken to perform the cerclage sacrohysteropexy in a hospital setting as outpatient surgery. A single case of symptomatic apical uterovaginal prolapse is demonstrated in this video. A non-elastic synthetic sling mesh was prepared by creating a mesh loop with permanent suture on one end and a suture tail on the other end. Blunt dissection is performed at the uterine isthmus, and the mesh is placed through the broad ligament medial to the uterine vessels. The tail end of the cerclage is then sutured to the anterior longitudinal ligament of the sacrum. The mesh is covered by reapproximating the peritoneum.

Clinical Relevance: The laparoscopic cerclage sacrohysteropexy results in excellent apical support while avoiding hysterectomy and laparoscopic suture placement on the uterus, vagina or cervix. This procedure results in less operating time than traditional sacral suspension procedures with mesh augmentation. Further validation of these findings is warranted to establish the long-term benefits of this time-efficient approach.