title: Apical sling: an approach to posthysterectomy vault prolapse.
abstract: OBJECTIVE
  This video demonstrates a transvaginal technique for vaginal vault suspension using an apical sling suspended from the sacrospinous ligaments.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Alexandriah N
authors.initials: AN
authors.lastname: Alas
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Ines
authors.initials: I
authors.lastname: Pereira
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Chandrasekaran
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Hemikaa
authors.initials: H
authors.lastname: Devakumar
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Espaillat
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Hurtado
authors.affiliation: Department of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA. davilag@ccf.org.
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000601:surgery*; D010388:Pelvis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D053825:Suburethral Slings; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery
keywords: Apical sling; Pelvic organ prolapse; Sacrospinous ligament fixation; Vault prolapse