Apical sling: an approach to posthysterectomy vault prolapse


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.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.


  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

  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):1424–1433

  3. 3.

    Chinthakanan OG (2013) Validation of the improvement satisfaction scale (ISS) for pelvic organ prolapse surgery. Female Pelvic Med Reconstr Surg 19(5):S151

  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):1106–1109

  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):453–461

  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

  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

  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

Download references

Author information

Correspondence to G. Willy Davila.

Ethics declarations



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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MP4 217459 kb)


(MP4 217459 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alas, A.N., Pereira, I., Chandrasekaran, N. et al. Apical sling: an approach to posthysterectomy vault prolapse. Int Urogynecol J 27, 1433–1436 (2016).

Download citation


  • Pelvic organ prolapse
  • Vault prolapse
  • Sacrospinous ligament fixation
  • Apical sling