Following is a brief summary of the surgical procedure for vaginal vault prolapse repair.

Caution: This information is for educational purposes only. Refer to operating room manuals and procedure videos for more detailed instructions on this surgical procedure.

Step 1
Place sutures for reference at the apex, one mid-point and one at each lateral uterosacral dimple points.

Step 2
Make a small stab incision 3 cm lateral and 3 cm posterior from anus. Repeat on contralateral side.

Step 3
Use preferred dissection method of posterior wall. Leave about 2 cm of vaginal wall below the apex intact for attachment.

Step 4
Dissect toward the ischial spine and palpate it with index finger.

Step 5
Insert needle tip through stab incision with handle in the 12 o'clock position.

Step 6
Use your forefinger to palpate needle tip below the levator. This hand placement helps protect the rectum.

Step 7
Palpate the ischial spine. Continue to guide needle along the lateral pelvic sidewall toward the ischial spine. Penetrate the levator muscle within 1 cm of the ischial spine on the distal side. Repeat needle passage on the contralateral side.

Step 8
Connect mesh to the needle. The needle tip should remain in a position next to the ischial spine inside the vaginal incision. A hemostat may be used to assist with the connection by clamping on sheaths next to dilator.

Step 9
Retract needles through skin incisions.

Step 10
Attach the middle portion of the graft at the level of the graft arms to the vaginal apex using preferred type of suture.

Step 11
Continue with repair of posterior defects, if needed. Avoid placing any tension while suturing the mesh. Close rectovaginal fascia over the mesh and close vaginal incision.

Step 12
Adjust final position of the vault by pulling graft arms. Do not apply tension. Remove plastic sheaths. Cut mesh ends and close stab incisions.