Robot-Assisted Laparoscopic Sacrohysteropexy with Autologous Fascia Lata

Abstract

Introduction and hypothesis: Autologous fascia lata has been increasingly utilised in pelvic floor reconstructive surgeries such as sacrocolpopexy and sacrohysteropexy. This case highlights sacrohysteropexy with autologous fascia lata as a promising option for women with advanced uterovaginal prolapse who wish to preserve their uterus and avoid synthetic mesh.

Methods: We report the case of a 65-year-old woman with stage 3 pelvic organ prolapse following one forceps and one spontaneous vaginal delivery. She presented with cervical-dominant prolapse (6 cm beyond the hymen) and a widened genital hiatus. She was initially managed with a Gellhorn pessary for 7 months, which was removed before surgery. Preoperative findings included prolapse of the cervix, anterior, and posterior vaginal walls (+ 1 cm distal to the hymen). A robot-assisted laparoscopic sacrohysteropexy with autologous fascia lata was performed.

Results: The 120-min procedure, conducted by a certified urogynaecologist, began with harvesting a 12 × 4 cm autologous fascia lata graft from the left thigh. The graft site was closed with 2-0 absorbable sutures and supported with a compression bandage for 4 weeks. The graft was secured to the cervix and anterior longitudinal ligament through laparoscopic dissection and robot-assisted suturing. No perioperative complications occurred, and the patient was discharged on postoperative day 2. At 1-year follow-up, there was no recurrence of prolapse.

Conclusions: Sacrohysteropexy using autologous fascia lata is a feasible and effective alternative to synthetic mesh, providing an additional surgical treatment option for women in settings where synthetic polypropylene meshes are not approved, contraindicated, or an unacceptable option.

Keywords: Apical prolapse; Fascia lata; Pelvic organ prolapse; Robotic surgery; Sacrocolpopexy; Sacrohysteropexy.