International Urogynecology Journal

, Volume 27, Issue 9, pp 1433–1436 | Cite as

Apical sling: an approach to posthysterectomy vault prolapse

  • Alexandriah N. Alas
  • Ines Pereira
  • Neeraja Chandrasekaran
  • Hemikaa Devakumar
  • Luis Espaillat
  • Eric Hurtado
  • G. Willy DavilaEmail author
IUJ Video


Introduction and hypothesis

This video demonstrates a transvaginal technique for vaginal vault suspension using an apical sling suspended from the sacrospinous ligaments.


This was a retrospective review of apical sling procedures performed from July 2013 to November 2014. The technique is started by marking the vaginal apex. A posterior dissection is performed and the sacrospinous ligaments are identified after dissection into the pararectal space. A 10-cm piece of monofilament, inelastic polypropylene tape is attached to the underside of the vaginal apex. Polypropylene sutures are placed into the sacrospinous ligament and threaded though the lateral edges of the apical sling and tied down, restoring apical support. Finally, the vaginal epithelium is closed.


A total of 67 women underwent an apical sling procedure with 70 % (47/67) completing 6 months follow-up. The subjective cure rate (“cured” or “greatly improved”) was 78.7 % and the objective cure rate (anatomical success, defined as apical prolapse stage ≤1) was 100 % (47 patients).


Our apical sling sacrospinous ligament fixation approach is a unique, minimal mesh approach using a tape commonly used for midurethral slings to suspend the vaginal apex. We achieved high anatomical success and patient satisfaction.


Pelvic organ prolapse Vault prolapse Sacrospinous ligament fixation Apical sling 


Compliance with ethical standards



Conflicts of interest

G.W. Davila received an honorarium from American Medical Systems, and CL Medical. He also is a consultant for American Medical Systems, and received research funding through Coloplast. The other authors have no disclosures or conflicts of interest to declare.


Written informed consent was obtained from the patient for publication of this Video article and any accompanying images.

Supplementary material


(MP4 217459 kb)


  1. 1.
    Barber MD, Brubaker L, Burgio KL et al (2014) Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 311(10):1023–1034. doi: 10.1001/jama.2014.1719 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Morgan DM, Rogers MA, Huebner M, Wei JT, Delancey JO (2007) Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review. Obstet Gynecol 109(6):1424–1433CrossRefPubMedGoogle Scholar
  3. 3.
    Chinthakanan OG (2013) Validation of the improvement satisfaction scale (ISS) for pelvic organ prolapse surgery. Female Pelvic Med Reconstr Surg 19(5):S151Google Scholar
  4. 4.
    Pariente JL, Villars F, Bram R, Ibarboure E (2005) Mechanical evaluation of various suburethral tapes used for the treatment of stress urinary incontinence. Prog Urol 15(6):1106–1109PubMedGoogle Scholar
  5. 5.
    Petros PP (1996) The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female. Aust N Z J Obstet Gynaecol 36(4):453–461CrossRefPubMedGoogle Scholar
  6. 6.
    Vardy MD, Brodman M, Olivera CK, Zhou HS, Flisser AJ, Bercik RS (2007) Anterior intravaginal slingplasty tunneller device for stress incontinence and posterior intravaginal slingplasty for apical vault prolapse: a 2-year prospective multicenter study. Am J Obstet Gynecol 197(1):104.e101–104.e108. doi: 10.1016/j.ajog.2007.03.056 CrossRefGoogle Scholar
  7. 7.
    Cosma S, Preti M, Mitidieri M, Petruzzelli P, Possavino F, Menato G (2011) Posterior intravaginal slingplasty: efficacy and complications in a continuous series of 118 cases. Int Urogynecol J 22(5):611–619. doi: 10.1007/s00192-010-1350-7 CrossRefPubMedGoogle Scholar
  8. 8.
    Su TH, Lau HH, Huang WC, Hsieh CH, Chang RC, Su CH (2014) Single-incision mesh repair versus traditional native tissue repair for pelvic organ prolapse: results of a cohort study. Int Urogynecol J 25(7):901–908. doi: 10.1007/s00192-013-2294-5 CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  • Alexandriah N. Alas
    • 1
  • Ines Pereira
    • 1
  • Neeraja Chandrasekaran
    • 1
  • Hemikaa Devakumar
    • 1
  • Luis Espaillat
    • 1
  • Eric Hurtado
    • 1
  • G. Willy Davila
    • 1
    Email author
  1. 1.Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive SurgeryCleveland Clinic FloridaWestonUSA

Personalised recommendations