Watch this detailed video on Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair. Learn step-by-step how minimally invasive techniques are applied for safe and effective prolapse correction. This surgical video provides insights into modern gynecological surgery, showcasing expert procedures, patient care, and advanced laparoscopic techniques.

Sacrocolpopexy with hysterectomy using mesh for uterine prolapse is performed with the patient under general anaesthesia. Laparoscopic approach is used, following on from a concomitant hysterectomy. Mesh is attached to the apex of the vagina and may also be attached to the anterior and/or posterior vaginal wall, with the aim of preventing future vaginal vault prolapse. Several different types of synthetic and biological mesh are available, which vary in structure and in their physical properties such as absorbability.

Uterine prolapse is a condition where the uterus descends from its normal position into the vaginal canal due to weakness of the pelvic floor muscles and ligaments. It is a common gynecological issue, especially among women who have had multiple vaginal deliveries, aging, or other factors weakening pelvic support. Severe prolapse can significantly impact quality of life, causing urinary problems, pelvic pressure, discomfort, and sexual dysfunction.

Surgical intervention is often required for moderate to severe prolapse, and sacrocolpopexy with hysterectomy using mesh is considered one of the most effective and durable solutions.

What is Sacrocolpopexy?

Sacrocolpopexy is a surgical procedure that restores the normal position of the vaginal vault by attaching it to the sacrum (the lower part of the spine) using a supportive material, typically synthetic mesh. When performed in combination with a hysterectomy (removal of the uterus), it addresses uterine prolapse and prevents recurrence, providing long-term pelvic support.

Indications for Sacrocolpopexy with Hysterectomy

• Symptomatic uterine prolapse (stage II–IV)

• Vaginal or pelvic pressure, bulging, or discomfort

• Urinary incontinence or retention associated with prolapse

• Failure of conservative treatments such as pessaries or pelvic floor exercises

This surgery is particularly recommended when there is significant uterine descent or when the patient prefers definitive management of prolapse along with removal of the uterus.

Surgical Procedure Overview

1. Hysterectomy:

   • The uterus is removed via minimally invasive laparoscopic or robotic-assisted surgery.

   • Care is taken to preserve the surrounding structures, including ligaments and ureters.

2. Mesh Placement:

   • A synthetic surgical mesh is used to support the vaginal vault.

   • The mesh is anchored to the anterior and posterior vaginal walls and attached securely to the sacral promontory.

3. Restoration of Pelvic Anatomy:

   • The mesh elevates the vaginal vault to its normal anatomical position, providing strong, long-lasting support.

   • Excess tissue is removed, and the vaginal walls are reinforced.

4. Closure and Recovery:

   • The surgical site is closed with minimally invasive techniques.

   • Recovery is faster than traditional open surgery, and most patients can resume normal activities within a few weeks.

Advantages of Sacrocolpopexy with Mesh

• Durable repair: Lower recurrence rates compared to native tissue repairs

• Anatomic restoration: Maintains the normal axis and depth of the vagina

• Minimally invasive options: Laparoscopic and robotic-assisted approaches reduce pain and hospital stay

• Improved quality of life: Relief from prolapse symptoms and better pelvic function

Risks and Considerations

As with any surgery, sacrocolpopexy carries potential risks:

• Mesh-related complications (erosion, infection, or exposure)

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

• Infection at surgical sites

• Recurrence of prolapse (rare with proper technique)

A thorough preoperative assessment and counseling are essential to minimize complications and ensure the patient’s expectations are realistic.

Recovery and Postoperative Care

• Hospital stay is usually 1–3 days for laparoscopic or robotic surgery.

• Avoid heavy lifting and strenuous activities for 6–8 weeks.

• Pelvic floor exercises may be recommended after healing.

• Regular follow-up is crucial to monitor mesh integration and detect any complications early.

Conclusion

Sacrocolpopexy with hysterectomy using mesh is a gold-standard surgical approach for severe uterine prolapse. It provides durable pelvic support, restores normal anatomy, and significantly improves quality of life for affected women. With advancements in minimally invasive techniques, this procedure has become safer, less painful, and associated with faster recovery, making it a preferred choice for both patients and surgeons.