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.