Robot-Assisted Laparoscopic Sacrohysteropexy with Autologous Fascia Lata

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.

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.

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.

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.