Robotic sacrohysteropexy: an instructional video for uterovaginal prolapse repair in patients with desired uterine preservation

Introduction Minimally invasive sacrohysteropexy is a feasible and safe option for the treatment of uterovaginal prolapse in patients with prior sacrorectopexy. This video demonstrates an approach to robotic sacrohysteropexy while also adapting for a patient’s prior sacrorectopexy. Sacrohysteropexy has been shown to be a viable option in women undergoing pelvic reconstructive surgery for the repair of uterovaginal prolapse. Methods This video demonstrates key steps in performing a robotic sacrohysteropexy without compromising the integrity of the patient’s prior sacrorectopexy. First, incision and dissection of the anterior and posterior peritoneum overlying the cervical stroma is carried out. Tunnels are made through the avascular plane of the broad ligament lateral to the uterine vessels, so as not to compromise uterine blood supply. The anterior and posterior arms of the mesh are attached with interrupted sutures to the cervical stroma. The presacral space is entered and dissected such that the anterior longitudinal ligament is exposed. Care is taken not to disrupt the sutures from the prior sacrorectopexy as the sacral arm of the mesh is secured with two interrupted stitches. Conclusion At completion of the procedure the patient had a well-supported apical compartment.