The patient is a 48-year-old, gravida 3, para 3 female with a history of symptomatic uterovaginal prolapse and menometorrhagia. The procedure begins with a laparoscopic supracervical hysterectomy, as is our preference if there is no contraindication to leaving the cervix. The robotic harmonic scalpel is utilized in these cases to allow efficient and hemostatic hysterectomy. Care is taken to identify the ureters bilaterally before proceeding with broad ligament dissection. The uterine corpus is amputated from the cervix and allowed to fall into the upper abdomen. Bipolar energy is used to cauterize the endocervix. The vesicouterine peritoneum is opened along an avascular plane using judicious cautery and blunt dissection. Similarly, the posterior cervical vaginal plane is opened by incising the uterosacral ligaments, creating an avascular attachment point for the posterior vaginal graft. Attention is turned to the sacral promontory, which is visually identified and also palpated with a suction irrigation tip. The peritoneum overlying the promontory is opened and the medial longitudinal ligament is identified and then exposed using a spreading technique with minimal cauter utilization. The peritoneum is opened distally with careful attention paid to the position of the right ureter. The upsilon Y-mesh is then introduced through the right lower quadrant cystin port. A dual-ended 2-0 Stratafix PDO suture with a cutting needle is utilized to attach the graft to the anterior and posterior cervical stump. Similarly, the posterior arm of the Y-mesh is attached to the posterior aspect of the cervix using a concentric circle technique. The Stratafix suture is cut flush with the mesh graft and the needles are removed via the right lower quadrant cystin port. Interrupted sutures of Ogortex are placed through the medial longitudinal ligament of the sacrum. The sutures are secured to the mesh using a slipknot tying technique. A total of three to four sutures are placed. The mesh is then trimmed in preparation for peritoneal closure. A 2-0 Stratafix single-looped PDS suture is used to close the peritoneum. Closing of the peritoneum begins along the left side of the pelvis and a running closure brings the anterior and posterior leaves of peritoneum together. The right ureter is again visualized to ensure normal vermiculation after peritoneal closure. The uterine corpus is morcellated using the Linna excise morcellator and all pieces are carefully accounted for. Final inspection reveals a hemostatic repair. The patient is discharged home from the PACU with minimal discomfort and oral pain meds.

uterovaginal prolapse

menometorrhagia

laparoscopic supracervical hysterectomy

robotic harmonic scalpel

vaginal graft