Laparoscopic Sacral Colposuspension - Prolapse

Symptoms

A 68 year old woman presented with complete procidentia (a very large prolapse of uterus and bladder).

Diagnosis

Conservative measures including pelvic floor exercises are ineffective for a very large prolapse.

Procedure

She subsequently underwent surgical intervention - Total Laparoscopic Hysterectomy and Laparoscopic Sacral Colposuspension.

Outcome

Follow up at 4 months revealed a well supported vaginal vault. She was very satisfied with the outcome.

 The laparoscopic view of the uterus.

Dissection at the sacral promontory for later attachment of the sling.

Careful dissection of the bladder - to allow attachment of the sling and high elevation of the vagina.

Total Laparoscopic Hysterectomy and removal of both tubes and ovaries.

The vaginal vault is carefully closed laparoscopically.

The vaginal vault - ready for the sling to be sutured.

The sling is sutured to the vaginal vault and elevated to the sacral promontory.

The pelvis at the end - the peritoneum is closed over the sling to minimise scarring.