Robotic Assisted Laparoscopic Apical Suspension. 4 points technique (RALAS-4).

This video shows a surgical technique of robotic assisted laparoscopic apical suspension (RALAS) using non- absorbable sutures and describe a new 4 points technique (RALAS-4) fo pelvic organ propalpse. 73- year-old woman, gravida 5, para 4 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and was sexually active. The most relevant complaints were vaginal bulging, pressure and urinary incontinence, mainly stress urinary incontinence; she is using 5 - 7 pads/day. RALAS-4 may represents an alternative to robotic or laparoscopic sacrocolpopexy. This new approach simulate the natural 4 points support given by uterosacral ligaments and cardinal ligament, with the additional benefit of no mesh and no dissection on the sacrum promontory.