Pelvic organ prolapse is a common condition affecting millions of women worldwide, particularly after childbirth, menopause, or previous pelvic surgeries. When uterine prolapse is associated with vaginal vault weakness, advanced minimally invasive procedures such as Total Laparoscopic Hysterectomy (TLH) combined with Sacrocolpopexy provide an effective and durable solution. A "Skin-to-Skin" surgical demonstration offers a complete view of the procedure, beginning from the first incision and continuing through the final skin closure, allowing surgeons to appreciate every critical step of the operation.

Total Laparoscopic Hysterectomy (TLH) involves the complete removal of the uterus using laparoscopic techniques through small abdominal incisions. The procedure provides numerous advantages over conventional open surgery, including reduced postoperative pain, shorter hospital stay, faster recovery, minimal blood loss, and superior cosmetic outcomes.

Sacrocolpopexy is considered the gold standard procedure for correcting vaginal vault prolapse. During this operation, a synthetic mesh is attached to the vaginal apex and secured to the sacral promontory, restoring normal pelvic anatomy and providing long-term support. When performed simultaneously with hysterectomy, sacrocolpopexy addresses both the diseased uterus and pelvic floor dysfunction in a single surgical session.

The skin-to-skin approach begins with careful patient positioning in the dorsal lithotomy position. Following induction of general anesthesia, sterile preparation and draping are performed. Pneumoperitoneum is established, and laparoscopic ports are inserted under direct visualization. Initial inspection of the abdominal and pelvic cavity helps identify anatomical landmarks and any associated pathology.

The hysterectomy phase starts with coagulation and division of the round ligaments, followed by careful dissection of the broad ligaments. The bladder is mobilized downward to expose the lower uterine segment and cervix. Uterine vessels are skeletonized, sealed, and divided with advanced energy devices. The cardinal and uterosacral ligaments are transected, allowing complete detachment of the uterus. Colpotomy is performed circumferentially, and the specimen is removed vaginally. The vaginal cuff is then securely closed laparoscopically.

Following hysterectomy, attention is directed toward pelvic reconstruction. The sacral promontory is identified, and meticulous dissection is carried out to expose the anterior longitudinal ligament. The peritoneum overlying the sacrum is opened, creating a pathway for mesh placement. The anterior and posterior vaginal walls are carefully dissected to create adequate space for mesh fixation.

A Y-shaped polypropylene mesh is commonly utilized for sacrocolpopexy. The anterior arm of the mesh is attached to the anterior vaginal wall, while the posterior arm is secured to the posterior vaginal wall using non-absorbable or delayed-absorbable sutures. The proximal end of the mesh is then anchored firmly to the anterior longitudinal ligament of the sacral promontory. Proper tension adjustment is crucial to restore normal vaginal axis without excessive traction.

Once satisfactory support has been achieved, the mesh is completely covered by re-peritonealization. This step minimizes the risk of bowel adhesions and mesh-related complications. Hemostasis is carefully confirmed throughout the operative field. The abdominal cavity is irrigated, and all surgical sites are inspected before trocar removal.

The final stage of the skin-to-skin procedure involves closure of port sites and application of sterile dressings. Patients typically experience minimal postoperative discomfort and are encouraged to ambulate early. Most patients can resume routine activities within a few weeks, significantly sooner than after traditional open surgery.

The combination of Total Laparoscopic Hysterectomy and Sacrocolpopexy represents a remarkable advancement in gynecologic and pelvic reconstructive surgery. It offers durable anatomical correction, improved quality of life, restoration of pelvic support, and excellent long-term outcomes. A complete skin-to-skin surgical demonstration provides invaluable educational insight into the technical nuances, anatomical considerations, and operative strategies required for successful execution of this advanced minimally invasive procedure.

As laparoscopic expertise continues to evolve, TLH combined with Sacrocolpopexy remains a cornerstone procedure for managing uterine prolapse and pelvic floor disorders, delivering exceptional results while maintaining the principles of minimally invasive surgery.