The apex or top of the vagina (i.e. where the uterus/cervix meet) is the anchor of the pelvic floor support. When the top of the vagina/vaginal vault drops or falls (vaginal vault prolapse), it allows the rest of the pelvic floor support to be affected and causes the cystocele (bladder drop) or rectocele (rectum bulging into vagina) present to drop further. It is critical to support the top of the vagina during any pelvic floor repair, including cystocele or rectocele as it has been shown that many failures of prolapse surgery are caused by inadequate support of the vaginal vault. Many surgeons do not complete vaginal vault support at the time of prolapse repair as the diagnosis is missed, or they are not properly trained in vault procedures.
The vault suspension is completed laparoscopically at the time of prolapse repair. This procedure can be completed with mesh (sacralcolpopexy) or without mesh (uterosacral suspension) depending on the extent of the prolapse and the patient’s desires. Recently, mesh has been given a bad name in pelvic floor surgery (due to vaginal mesh kits such as Prolift), however the FDA as well as major organizations such as the American Urogynecologic Association and the American Urologic Association have stated that mesh used abdominally with sacralcolpopexy is considered safe and effective. Our doctors have published the largest literary series in the world on the Laparoscopic Sacralcolpopexy and are considered worldwide leaders in this technology. They have surgeons travel from throughout the world to come to learn their minimally invasive technique and have recently won International Awards for their video showing increased efficiency of the laparoscopic approach compared to the robotic approach.