This video demonstrate laparoscopic sacrocolpopexy foe vaginal vault prolapse demonstration by Dr R K Mishra at World Laparoscopy Hospital. After a hysterectomy the top of the vagina, where the neck of the womb (cervix) used to be, is called the vault. The vaginal vault can sag down, known as a vault prolapse. A laparoscopic sacrocolpopexy operation involves supporting the vaginal vault using a piece of permanent artificial mesh material. Sacrocolpopexy (sacral colpopexy) is a surgical technique for repairing pelvic organ prolapse. Reconstruction is achieved with an open abdominal technique or with the use of minimally invasive techniques.

Vaginal vault prolapse is a condition that occurs when the top of the vagina loses support after a hysterectomy, leading to a descent of the vaginal apex. This can cause discomfort, urinary or bowel symptoms, and sexual dysfunction, significantly affecting a woman's quality of life. Laparoscopic sacrocolpopexy (LSC) is a minimally invasive surgical technique that restores vaginal support by attaching the vaginal vault to the sacral promontory using a mesh, providing long-term anatomical and functional correction.

Indications

Laparoscopic sacrocolpopexy is primarily indicated in women with:

• Vaginal vault prolapse following hysterectomy

• Symptomatic pelvic organ prolapse affecting bladder, bowel, or sexual function

• Desire for durable repair with minimal recurrence risk

It is particularly preferred in patients who want to avoid a transvaginal approach and seek a minimally invasive option with faster recovery.

Preoperative Evaluation
Prior to surgery, patients undergo a thorough evaluation, including:

• Detailed pelvic examination to assess the degree of prolapse

• Urodynamic studies if urinary symptoms are present

• Imaging (ultrasound or MRI) for complex pelvic anatomy

• Assessment of comorbidities and suitability for laparoscopic surgery

Surgical Technique

1. Patient Positioning and Anesthesia
   The patient is placed in a lithotomy position under general anesthesia. Pneumoperitoneum is established, and laparoscopic ports are inserted.

2. Exposure and Dissection
   The peritoneum over the sacral promontory is opened, and the rectovaginal and vesicovaginal spaces are carefully dissected to mobilize the vaginal vault.

3. Mesh Placement
   A synthetic mesh is attached to the anterior and posterior vaginal walls. The other end of the mesh is secured to the sacral promontory using non-absorbable sutures. This creates durable suspension of the vaginal apex.

4. Peritoneal Closure
   The mesh is completely covered by peritoneum to prevent adhesions and minimize the risk of complications. Hemostasis is ensured, and ports are closed.

Advantages of Laparoscopic Sacrocolpopexy

• Minimally invasive with smaller incisions

• Reduced postoperative pain

• Shorter hospital stay and faster recovery

• High success rate with low recurrence

• Preserves vaginal length and sexual function

Potential Complications
While LSC is generally safe, possible complications include:

• Bleeding or injury to surrounding organs (bladder, bowel, ureters)

• Mesh-related complications (erosion, infection)

• Postoperative urinary retention or constipation

• Rare recurrence of prolapse

Postoperative Care and Recovery

• Patients are usually discharged within 1–2 days

• Light activity is encouraged, avoiding heavy lifting for 6–8 weeks

• Follow-up includes pelvic examination and assessment of symptoms

Conclusion
Laparoscopic sacrocolpopexy is a highly effective and safe surgical option for women with vaginal vault prolapse. With its minimally invasive approach, durable results, and low recurrence rates, it has become the gold standard for prolapse repair after hysterectomy. Careful patient selection, meticulous surgical technique, and proper postoperative care are key to achieving optimal outcomes.