This video demonstrate Laparoscopic Hysterectomy with Sacrocolpopexy for Uterine Prolapse performed by Dr R K Mishra at World Laparoscopy Hospital. Total Laparoscopic Hysterectomy with Sacrocolpopexy is performed in order to correct prolapse and/or herniation of the vagina, uterus, and bladder. In this procedure, which is done in conjunction with a laparoscopic hysterectomy, mesh is used to anchor the cervix to the anterior longitudinal ligament of sacrum, thereby lifting the vagina and bladder into their normal anatomic positions. Laparoscopic sacrocolpopexy can also be performed in women who have suffered a prolapse of the vagina and sometimes the intestines as well—a condition known as enterocele. Traditional open abdominal sacrocolpopexy has been shown to be a durable and successful method of repairing symptomatic prolapse while maintaining natural vaginal depth and length. We have now adapted the techniques utilized in open surgery to laparoscopic sacrocolpopexy. Laparoscopic surgery offers a minimally invasive approach with several technical advantages for the surgeon, including enhanced visualization with magnification, reduced blood loss, improved suturing techniques. Laparoscopic sacrocolpopexy avoids the need for a large abdominal incision, women undergoing this procedure are able to experience a less painful recovery with a significantly quicker return to normal activities than would be possible with open surgery. In this procedure, the patient is placed under general anesthesia and five small incisions are made in the lower abdomen, allowing introduction of a camera, three robotic instrument arms and one accessory port for passage of sutures and mesh materials. In cases of advanced uterine prolapse, a hysterectomy will then be performed with preservation of the cervix. Following this, a small piece of polypropylene mesh is used to anchor the cervix, vagina and bladder to the anterior longitudial ligament of sacral bone. In some cases, the uterus can be preserved and suspended in a similar manner—a procedure known as sacrohysteropexy. Finally, tissues are sewn over the mesh to form a barrier between the mesh and surrounding pelvic organs.

Uterine prolapse is a common condition among elderly women, often resulting from weakened pelvic floor muscles, connective tissue deterioration, and the effects of aging, childbirth, or hormonal changes. This condition can significantly impact quality of life, causing discomfort, urinary problems, sexual dysfunction, and psychological distress. Surgical intervention becomes necessary when conservative treatments like pelvic floor exercises, pessaries, or hormonal therapy fail. Among surgical options, laparoscopic hysterectomy with sacrocolpopexy has emerged as a minimally invasive and effective solution for elderly women with uterine prolapse.

Understanding the Procedure

Laparoscopic hysterectomy involves the removal of the uterus using small abdominal incisions, guided by a camera (laparoscope). When combined with sacrocolpopexy, the surgery not only removes the prolapsed uterus but also restores pelvic organ support by suspending the vaginal vault or uterus to the sacral promontory using a synthetic mesh. This approach offers several advantages over traditional open surgery, particularly in elderly patients.

Advantages in Elderly Women

1. Minimally Invasive: Laparoscopic surgery uses small incisions, reducing postoperative pain, scarring, and the risk of wound infections, which are crucial for elderly patients with slower healing.

2. Reduced Blood Loss: The laparoscopic approach minimizes intraoperative blood loss, decreasing the risk of transfusions, which can be critical in patients with comorbidities.

3. Faster Recovery: Most elderly patients experience shorter hospital stays and quicker return to normal activities compared to open abdominal procedures.

4. Durable Pelvic Support: Sacrocolpopexy provides long-lasting correction of prolapse with lower recurrence rates compared to vaginal repairs, which is particularly important in elderly women prone to connective tissue weakness.

5. Improved Quality of Life: Patients often report significant improvements in urinary and bowel function, sexual function, and overall comfort.

Preoperative Considerations
Elderly patients often present with comorbid conditions such as hypertension, diabetes, cardiovascular disease, or osteoporosis. Preoperative evaluation should include:

• Comprehensive medical assessment

• Imaging studies to assess pelvic anatomy

• Counseling about surgical risks and expected outcomes

• Optimization of medical comorbidities to reduce perioperative complications

Surgical Technique Overview

1. Anesthesia and Positioning: General anesthesia is administered, and the patient is positioned to allow optimal laparoscopic access.

2. Port Placement: Several small incisions are made to insert the laparoscope and surgical instruments.

3. Hysterectomy: The uterus is carefully detached from surrounding ligaments and blood vessels.

4. Sacrocolpopexy: A synthetic mesh is attached to the vaginal vault or uterine stump and anchored to the sacral promontory to restore normal pelvic support.

5. Closure and Recovery: The incisions are closed, and the patient is monitored for immediate postoperative complications.

Postoperative Care

• Early mobilization to prevent thromboembolic events

• Pain management tailored to elderly patients

• Monitoring for urinary retention or bowel dysfunction

• Pelvic floor physiotherapy to maintain long-term outcomes

Outcomes and Prognosis
Studies have shown that laparoscopic hysterectomy with sacrocolpopexy in elderly women has high success rates with minimal complications. Recurrence rates of prolapse are low, and patient satisfaction is generally excellent. Complications such as mesh erosion or infection are rare but require careful long-term follow-up.

Conclusion
Laparoscopic hysterectomy with sacrocolpopexy is a safe, effective, and minimally invasive treatment for uterine prolapse in elderly women. It provides durable pelvic support, enhances quality of life, and reduces the risks associated with traditional open surgery. With careful patient selection, thorough preoperative evaluation, and meticulous surgical technique, this approach represents a gold standard in the management of pelvic organ prolapse in the elderly population.