Meshless Vault Suspension VIA Permanent Suture to the Sacral Promontory During Laparoscopic Hysterectomy: A Prospective Pilot Study of Safety and Efficacy
Sushila Saini
ABSTRACT
Objective: To evaluate the feasibility, safety, and 12-month efficacy of a novel meshless laparoscopic vault suspension technique using permanent suture anchored to the sacral promontory in high-grade uterine prolapse.
Methods: A prospective pilot study was conducted on 10 women (POP-Q Stage III/IV) undergoing Total Laparoscopic Hysterectomy (TLH). Apical support was achieved using #2 Ethibond permanent suture, suspending the vaginal vault to the anterior longitudinal ligament (ALL) at the sacral promontory. A strategic peritoneotomy was performed to lateralize the ureter, ensuring surgical safety.
Results: All procedures were completed laparoscopically with a mean operative time of 85 ± 15 minutes. No intraoperative complications or ureteral injuries occurred. At 12-month follow-up, the recurrence rate for vault prolapse was 0% (all patients POP-Q stage ≤1), and subjective patient satisfaction was 9.8/10 on a Visual Analogue Scale.
Conclusion: This “Suture Sacrocolpopexy” provides the anatomical durability of a promontory anchor while eliminating mesh-related risks (erosion, infection, dyspareunia) and minimising ureteral complications. The technique is cost-effective and highly reproducible, making it a viable alternative to traditional mesh-based repairs.
