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This video demonstrates the step-by-step technique of Laparoscopic Sacrocolpopexy for Vault Prolapse, highlighting key anatomical landmarks, mesh placement, and suturing methods. Ideal for gynecologists and laparoscopic surgeons seeking advanced minimally invasive surgical education.

Post-hysterectomy vaginal vault prolapse has a reported incidence of 0.36 to 3.6 per 1,000 woman years or a cumulative incidence of 0.5%. Laparoscopic sacrocolpopexy was first reported in 1994. Laparoscopic sacrocolpopexy has potential advantages over laparotomy, as morbidity, hospital stay, postoperative pain and recovery are all supposed to be less. Moreover, the aesthetic result is better after minimally invasive sacrocolpopexy. However, the laparoscopic approach is more challenging and the literature reports a long learning curve associated with this technique. More importantly, it is unknown if the laparoscopic mesh fixation to the promontory results in an equal anatomical outcome, as it has been stated that as part of the laparoscopic approach, the fixation point is higher, which could result in a more vertical position of the vagina. 

Vault prolapse is a distressing condition that can occur in women following hysterectomy, where the top of the vagina (vaginal vault) loses its support and descends into the vaginal canal. This condition can significantly affect a woman’s quality of life, leading to symptoms such as a feeling of pelvic pressure, vaginal bulge, urinary dysfunction, bowel disturbances, and sexual discomfort. Laparoscopic sacrocolpopexy has emerged as the gold-standard surgical procedure for the management of vault prolapse, offering excellent long-term outcomes with the benefits of minimally invasive surgery.

Understanding Vault Prolapse

After hysterectomy, the natural support structures of the vagina—such as the uterosacral and cardinal ligaments—may become weakened or disrupted. Over time, this can result in prolapse of the vaginal vault. Risk factors include advanced age, multiple vaginal deliveries, obesity, chronic cough, constipation, and connective tissue disorders. Surgical correction is often required when symptoms are severe or progressive.

Principle of Laparoscopic Sacrocolpopexy

Laparoscopic sacrocolpopexy aims to restore normal vaginal anatomy by suspending the vaginal vault to the anterior longitudinal ligament over the sacral promontory using a synthetic mesh. This recreates strong apical support while preserving vaginal length, axis, and sexual function. The laparoscopic approach allows precise dissection and secure mesh fixation with minimal tissue trauma.

Surgical Technique Overview

The procedure is performed under general anesthesia with the patient in the lithotomy position. After establishing pneumoperitoneum, laparoscopic ports are placed. The sacral promontory is identified, and careful dissection is carried out to expose the anterior longitudinal ligament while safeguarding nearby structures such as the ureter and major blood vessels.

The vaginal vault is then dissected anteriorly and posteriorly. A Y-shaped polypropylene mesh is commonly used—one arm attached to the anterior vaginal wall and the other to the posterior vaginal wall using non-absorbable or delayed-absorbable sutures. The proximal end of the mesh is secured to the sacral promontory, creating a tension-free suspension. Finally, the mesh is retroperitonealized to reduce the risk of bowel adhesions.

Advantages of the Laparoscopic Approach

Laparoscopic sacrocolpopexy offers several advantages over open surgery, including reduced postoperative pain, minimal blood loss, smaller incisions, shorter hospital stay, and faster recovery. The magnified view provided by laparoscopy enhances anatomical visualization, allowing meticulous dissection and accurate mesh placement, which contributes to lower recurrence rates.

Outcomes and Success Rates

Multiple studies have demonstrated high success rates for laparoscopic sacrocolpopexy, with durable anatomical correction and significant improvement in urinary, bowel, and sexual function. Recurrence rates are low, and patient satisfaction is generally high. When performed by experienced surgeons, complication rates—such as mesh erosion or sacral bleeding—are minimal.

Postoperative Care and Recovery

Patients are usually mobilized early and discharged within a few days. Light activities can be resumed within one to two weeks, while heavy lifting and strenuous exercise are avoided for several weeks. Long-term follow-up is important to monitor pelvic support and address any late complications.

Conclusion

Laparoscopic sacrocolpopexy for vault prolapse is a safe, effective, and durable surgical option that restores pelvic anatomy and improves quality of life. With its minimally invasive advantages and excellent long-term outcomes, it has become the preferred procedure for managing post-hysterectomy vault prolapse in modern gynecological practice. When performed by skilled laparoscopic surgeons, this technique offers women a reliable solution with rapid recovery and sustained results.