Laparoscopic Vault Suspension

Vaginal vault prolapse occurs when the apex of the vagina (upper 1/3 of the vagina) has broken away from its original support structure known as the uterosacral ligaments. The uterosacral ligaments hold up the apex and the uterus when the uterus is in place (Figure 1). When a patient has a hysterectomy, the uterosacral ligaments must be cut to remove the uterus. In an attempt at preventing future vaginal apex or vault prolapse, the uterosacral ligaments should be attached to the apex of the vagina after the uterus has been removed.

If the patient did not have her uterosacral ligament attached to the vaginal apex or the uterosacral ligaments did not remain attached after the surgery, the patient risks ending up with vaginal vault prolapse after the hysterectomy (Figure 2). As the prolapse continues to pull down, it will increase the risk of anterior and posterior paravaginal defects.

Figure 1: Uterine and vaginal vault prolapse
The uterus begins to prolapse because of the broken uterosacral ligament.

Figure 2: Vault prolapse
If the uterus is removed (hysterectomy) and the surgeon does not reattach the uterosacral ligament the patient is left with a vaginal vault prolapse. This prolapse can be repaired using a laparoscope when incisions are made in the lower abdomen and permanent stitches are used to reattach the vagina to the uterosacral ligaments.