How to perform unilateral pectineal suspension for apical prolapse by robotic assistance: A technical note with Video.

Sacrocolpopexy remains the gold-standard surgical technique for the management of apical prolapse, whether performed with or without concomitant hysterectomy. However, the use of synthetic mesh has become increasingly debated owing to concerns regarding postoperative complications. Robotic-assisted unilateral pectineal suspension (UPS) has emerged as an innovative, safe, and effective alternative for apical prolapse repair. This minimally invasive, mesh-free procedure achieves uterine suspension by anchoring the anterior cervical surface to Cooper's iliopectineal ligament. Indications include women of reproductive age seeking a uterus-preserving approach, obese patients, and those unwilling to undergo procedures involving synthetic prostheses; it may also represent a suitable option in selected cases of recurrence following laparoscopic sacrocolpopexy or vaginal repair. We describe the standardized steps of this surgical procedure, along with the specific advantages of the robotic approach, illustrated by a detailed video demonstration to support implementation among surgeons.