Conclusion
Laparoscopic sacrohysteropexy is becoming an increasingly popular alternative to hysterectomy to treat uterine prolapse in women. We present a novel approach of performing laparoscopic sacrohysteropexy that differs from previously described methods
1,
2; it is shorter, simpler, and reduces possible complications. Key differences include the mesh type, site of attachment, and dissection of the peritoneum while creating the possibility of future vaginal delivery after pregnancy. Our simplified technique uses a polyvinylidene fluoride mesh woven with a square weave secured to the posterior aspect of the cervix under a layer of visceral peritoneum. Because there is no longitudinal give of the mesh, unlike polypropylene meshes with a diamond weave, a wrap method
2] is not required. No dissection of the broad ligament and bladder is needed, eliminating the risk of bladder perforation and anterior mesh erosion with fewer adhesions and simplifying hysterectomy if required in the future. We also uniquely “tunnel” the peritoneum, reducing the size of defect for suture closure, and reperitonize the mesh. Previous methods restrict cervical dilatation and require women to have cesarean sections. The method described in the video allows women to deliver vaginally and, in the event of late miscarriage, avoid the need for hysterotomy. We have performed 25 cases with 1 mild cystocoele recurrence requiring no surgery, 1 reoperation for posterior compartment repair, and 1 case of cervical elongation requiring Manchester repair. No cases of recurrent uterine prolapse have occurred.
