Laparoscopic monolateral suspension for vaginal vault prolapse: A report of an exit surgical strategy during sacralcolpopexy

Research output: Contribution to journalArticlepeer-review


Background: Vaginal vault prolapse is the most frequent long-term complication in patients undergoing hysterectomy and sacralcolpopexy is considered the gold standard. We report our surgical strategy maintaining single-arm mesh when the sacral promontory is not accessible to fix the mesh for an unknown sacral osteophytosis during a laparoscopic sacralcolpopexy. This is significant because, to our knowledge, the bone variant as a procedure limiting factor has never been described before. This opens new horizons for the sacralcolpopexy surgery, because it becomes necessary to know of a valid surgical alternative with mesh maintenance if this complication occurs again or to perform an assessment of the accessibility of the sacral promontory immediately after its dissection. Case presentation: We present a case of a 75-year-old woman with recurrence of vaginal vault prolapse. A laparoscopic sacralcolpopexy was recommended. During surgery, we found that the procedure was not feasible due to the presence of an unknown osteophytosis of the sacrum which prevented the fixing of the mesh to the sacral promontory. We decided to proceed with a single-arm lateral suspension by using a modified approach of the original technique, maintaining the mesh originally shaped for the sacral colpopexy. At follow-up, the vaginal vault is well suspended. Conclusion: This exit strategy may represent a valid surgical alternative when laparoscopic sacral colpopexy is not possible for anatomical variants, allowing to keep the laparoscopic approach using mesh. To our knowledge, cases in which the anatomical bone variant prevented access to the sacral promontory have never been described in the literature, as bone evaluation has never been considered a limiting element of this procedure.

Original languageEnglish
Article number199
JournalBMC Surgery
Issue number1
Publication statusPublished - Sep 11 2020


  • Laparoscopic lateral colposuspension
  • Osteophytosis
  • Promontory dissection
  • Sacralcolpopexy
  • Vaginal vault prolapse

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Laparoscopic monolateral suspension for vaginal vault prolapse: A report of an exit surgical strategy during sacralcolpopexy'. Together they form a unique fingerprint.

Cite this