The treatment of vaginal vault prolapse is still challenging. Abdominal colposacropexy with syntethic mesh is considered the gold standard. Despite the good anatomical outcome, this tecnique is perfectible because of the risk of mesh complications, first of all exposure.
Some American authors have started using autologous graft obtained by fascia lata during colposacropexy, a strong and easily accessible tissue. No european experience is reported as far as we know.
Our objective was to evaluate the feasibility and safety of a technique for robotic sacrocolpopexy using autologous fascia lata mesh for the treatment of pelvic organ prolapse.

The video shows our technique for robotic sacrocolpopexy with autologous fascia lata.
The harvest of two pieces of fascia lata from dominant leg was obtained by orthopedist (8x4 cm and 15x3 cm), then robotic operating time was started by gynaecologists.
First piece was used to cover vaginal vault and reinforce anterior and posterior vaginal wall after extended dissection. Absorbable suture were used. The second piece was secured to the sacral promontory with two non absorbable sutures and attached to vaginal cuff.

The procedure was performed on 3 patients with vaginal vault prolapse after hysterectomy. 
Mean age was 73 years. One patient underwent concomitant posterior repair for rectocele. 
Colposuspension was very satisfying at a mean follow up of 6 months and all the patients improved their symptoms. Neither operative complications nor hernia at the harvest site occurred.

Robotic sacrocolpopexy with total autologous fascia lata is a feasible alternative to traditional surgery with synthetic mesh. Vaginal suspension is very satisfying at short- term follow up. Further studies are needed to verify the effectiveness over time.

Scott VCS et al. Robot-assisted laparoscopic sacrocolpopexy with autologous fascia lata: technique and initial outcomes. Int Urogynecol J. 2019 Nov;30(11):1965-1971.