Introduction
Apical prolapse, alone or in combination with anterior/posterior vaginal
wall prolapse, results from defects in the integrity of the uterosacral
and cardinal ligaments.1 Sacrocolpopexy and
hysteropexy are accepted as the gold standard treatments for apical
uterine prolapse.2 This repair consists of securing
the anterior and posterior vaginal walls to the anterior longitudinal
sacral ligament just below the sacral promontory using Y-shaped mesh.
Reduced blood loss, fast patient recovery and fewer incisional
morbidities are achieved by laparoscopic
sacrocolpopexy.3 However laparoscopic sacrocolpopexy
is a long and complicated procedure that requires specialized surgical
skills, including precise dissection, suturing and the use of advanced
laparoscopic equipment, or a robotic endoscopic unit to assist with
suturing and dissection. Concomitant hysterectomy at the time of
sacrocolpopexy, usually performed to facilitate access to the anterior
and posterior vaginal walls, is associated with increased cost,
morbidity and operation time.4, 5 Uterus-sparing
hysteropexy reduces mesh exposure, operative time, blood loss and
surgical cost with no differences in prolapse recurrence. Despite a
better understanding of apical support and advancements in surgical
techniques, there are still several problems associated with the
peritonization of mesh and a non-physiological position of the uterus or
vagina, including a relatively high recurrence rate, frequent mesh
exposure and complications such as ileus and ureter damage.
The novel operation technique presented here is an easy and minimally
invasive way to correct apical defects/concurrent apical and anterior
vaginal wall defects with the advantages of a minimal mesh load, short
operation time and optimum anatomical results that mimic normal support.