Design: Case report and an illustrative surgical video

Setting: The patient was positioned in a modified lithotomy and robotic assisted laparoscopy was performed using the Xi Intuitive platform. First trocar was inserted in the umbilical scar, three 8 mm robotic trocars and one 5 mm assistant trocar were positioned in line at the level of the umbilicus.

Patients or Participants: TG, a 48 year old female who presents with difficulty to evacuate, tenesmus and dyschezia. She also referred dysmenorrhea, but no deep dyspareunia. Her physical exam showed a stage 3 vaginal apex prolapse. Her defecography MRI showed adenomyosis, deep endometriosis in the posterior pelvic compartment, hypotonic internal anal sphincter, tapering of the external anal sphincter and of the iliococcygeus muscle, indirect signs of weakness of the endopelvic fascia, perineal descent with weakness of the elevator plaque and dissinergic evacuatory patterns.

Interventions: The patient was submitted to a laparoscopic robot assisted histeropexy. During the cavitary inventory, we found a normal sized uterus, multiple peritoneal endometriosis foci on the posterior cul de sac, ovarian fossa and appendix. The pelvic floor damage was also evident.

Measurements and Main Results: The procedure had no complications, and the patient had a good postoperative outcome, regarding endometriosis and pelvic organ prolapse symptoms.

Conclusion: Robot assisted laparoscopy promotes dexterity and a good anatomical visualization, which are important for high complex surgeries. Abdominal hysteropexy allows a satisfying correction of pelvic organs prolapse with fertility preservation.