Laparoscopic Hysterectomy with Sacrocolpopexy for Uterine Prolapse in Elderly Women

This video demonstrates 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, the 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 the 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 the preservation of the cervix. Following this, a small piece of polypropylene mesh is used to anchor the cervix, vagina and bladder to the anterior longitudinal 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.