Sacrohysteropexy with Anterior and Posterior Attachment

Abstract

Video Objective This video discusses patient selection, different surgical approaches, and outcomes data for sacrohysteropexy. We present a case presentation employing one of the approaches to sacrohysteropexy. Setting This video presents a case of a 40 year old female with Stage II uterovaginal prolapse who seeks a durable surgical repair. She does not desire future fertility and has risk factors for native tissue repair failure. Interventions The patient underwent a robotic-assisted laparoscopic sacrohysteropexy, bilateral salpingectomy, and posterior colporrhaphy. Conclusion Sacrohysteropexy is an effective and appropriate surgery for patients with uterovaginal prolapse and risk factors for native tissue failure who do not want a hysterectomy. Sacrohysteropexy can be performed with a posterior vaginal attachment only or with posterior and anterior vaginal attachments. The posterior only attachment is best for patients who may desire future fertility as it does not involve surgery into the broad ligament or anterior cul-de-sac. There are two approaches to sacrohysteropexy that also include an anterior attachment to provide anterior vaginal support. Both approaches bring anterolateral mesh arms through windows created in the broad ligament. One technique sutures these arms in addition to the posterior mesh's sacral arm to the sacral promontory. The other technique sutures the lateral arms to the posterior cervix leaving only the posterior mesh sacral arm to be attached at the sacral promontory. Overall sacrohysteropexy has been shown to have a symptomatic success rate of 90-95% and an anatomical success rate of 70%. Sacrohysteropexy has been shown to have reduced operative time, blood loss, hospital stay length, and to have greater vaginal length preservation than its hysterectomy with sacrocolpopexy alternative.