Use of autologous hamstring tendon in laparoscopic hysterosacropexy: short term outcomes from a prospective pilot study

OBJECTIVES: Minimally invasive pelvic organ prolapse (POP) surgery is increasingly globally, particularly for uterus-preserving procedures. While laparoscopic correction with synthetic mesh remains the standard approach, growing concern over mesh-related complications has prompted increasing interest in native tissue alternatives. Our prospective pilot study aimed to evaluate the feasibility, safety, and early clinical outcomes of laparoscopic hysterosacropexy using autologous tendon grafts for the correction of apical POP via patient reported outcomes (PROs). MATERIAL AND METHODS: We included women with symptomatic apical POP (≥ stage II, POP-Q).We excluded the patients with obesity, prior major abdominal or pelvic surgery, or prior knee procedures. Hamstring autografts (semitendinosus or gracilis) were harvested and used for apical suspension. Clinical evaluations were conducted preoperatively as well as at 6 weeks and 6 months postoperatively. In addition, PROs were measured using the PFIQ-7, UIQ-7, and CRAIQ-7 questionnaires. RESULTS: The mean age of the patients was 44.3 years (±10.75), and the mean body mass index was 21.72 kg/m² (± 2.4). At the 6-month postoperative follow-up, all patients achieved complete anatomical and functional success. Global PFIQ-7 scores demonstrated a marked reduction from a preoperative mean of 128.5 (± 82.06) to 23.0 (± 33.32) at 6 months (p value < 0.001).Significant changes were observed between the preoperative and 6-week assessments for UIQ-7 (p value = 0.008) and POPIQ-7 (p value = 0.012). CONCLUSIONS: Laparoscopic hysterosacropexy using autologous tendon grafts appears to be a safe and clinically effective mesh-free alternative for apical POP repair in the short term. Further randomized studies with larger cohorts and longer follow-up periods are warranted to validate long-term outcomes and to compare this approach more robustly with other techniques.