Laparoscopic suture sacrohysteropexy: A meshless uterinesparing technique for surgical management of uterine prolapse

Abstract

Background: Laparoscopic mesh sacrohysteropexy has been established as an effective, safe, and popular technique to treat uterine prolapse. Nevertheless, recent controversies regarding the role of synthetic mesh in pelvic reconstructive surgery have triggered a trend towards meshless procedures. Other laparoscopic native tissue prolapses techniques such as uterosacral ligament plication and sacral suture hysteropexy have been previously described in literature. Objectives: To describe a meshless minimally invasive technique with uterine preservation, which incorporates steps from the above-mentioned procedures. Materials and Methods: We present a case of a 41-year-old patient with stage II apical prolapse and stage III cystocele and rectocele, who was keen to proceed to surgical management preserving her uterus and avoiding the use of a mesh implant. The narrated video demonstrates the surgical steps of our technique of laparoscopic suture sacrohysteropexy. Main outcome measures: Objective (i.e., anatomic) and subjective (i.e., functional) surgical success on follow-up assessment at least 3 months post-surgery, similarly to every prolapse procedure. Results: Excellent anatomical result and resolution of prolapse symptoms at follow-up appointments. Conclusions: Our technique of laparoscopic suture sacrohysteropexy seems a logical progression in prolapse surgery, responding to patients’ wishes for minimally invasive meshless procedures with uterine preservation while at the same time achieving excellent apical support. Its long-term efficacy and safety need to be carefully assessed before it becomes established in clinical practice. Learning objective: To demonstrate a laparoscopic uterine-sparing technique to treat uterine prolapse without the use of a permanent mesh.