There has been increasing interest and utilisation of autologous fascia lata in pelvic floor reconstructive procedures such as sacrocolpopexy and sacrohysteropexy. Sacrohysteropexy with autologous fascia lata has recently been described as a promising option for women with advanced stage uterovaginal prolapse who wish to retain their uterus.

We present the case of a 65 year-old female with stage three uterovaginal prolapse in the setting of one previous forceps and one vaginal delivery. The cervix, anterior and posterior vaginal wall were prolapsed to 1cm (+1) distal to the hymenal remnant. The aim of this video was to describe the procedure of robot assisted laparoscopic sacrohysteropexy with autologous fascia lata.

The procedure was completed by an international expert in pelvic reconstructive surgery. Operating time was 120 minutes. The procedure begins with harvesting of the autologous fascia lata through a 3cm linear incision in the lateral aspect of the left leg, to obtain a 12x4 cm sheet of autologous fascia. The graft site was closed with 3-0 absorbable suture and a compression bandage was used to support the thigh for 48 hours. 

After laparoscopic entry and robotic port docking, the peritoneum anterior to the sacral promontory was dissected distally to the level of the posterior fornix, medial to the right uteroscacral ligament. The peritoneum of the uterovesical fold was also incised with the bladder reflected anteriorly to access the cervico-isthmic area. Two oval windows were created through the broad ligament. Pericervical support was reconstituted prior to suspension by suturing the anterior leaflet of fascia lata to the cervix with 2-0 prolene interrupted sutures. The posterior limb of the fascia lata was divided longitudinally and the two limbs were passed through the windows bilaterally prior to being sutured together with 2-0 stratafix to re-form a single posterior limb, which was subsequently suspended and secured to the anterior longitudinal ligament using 2-0 prolene interrupted sutures. Peritoneum was closed with 2-0 stratafix. No peri operative complication occurred. The patient was discharged two days after surgery and did not have recurrence of prolapse.

Sacrohysteropexy with autologous fascia lata is a feasible procedure which may serve as an additional surgical treatment options to women in settings where synthetic polypropylene materials are not approved or contra-indicated.

Continence 7S1 (2023) 101020
DOI: 10.1016/j.cont.2023.101020