Uterosacral or Sacrospinous Ligament Fixation - When a vaginal incision is preferred, the top of the vagina is most often suspended to a woman's own uterosacral ligament or the sacrospinous ligaments. Traditionally these procedures did not use graft material. Recently, more surgeons are adding graft reinforcement to the natural ligament suspensions in an effort to improve the durability of the prolapse repair when surgeons find the vaginal wall to be weak. Research studies are being conducted to determine if this desired benefit will result in superior outcomes. We sometimes use the da Vinci to shorten the uterosacral ligaments with an abdominal approach using permanent sutures to elevate the apex of the vagina with excellent results.