Operation Restoration: A Robotic Sacrocolpopexy Revision

INTRODUCTION: Sacrocolpopexy is known as the most durable repair for apical pelvic organ prolapse, with robust long-term success rates and sustained anatomical outcomes. Nevertheless, up to 5 –10% of patients require reoperation for recurrent prolapse, mesh complications, or other sequelae. These revision procedures present unique technical challenges due to adhesions and altered anatomy. Robot-assisted approaches have emerged as a valuable modality for revision sacrocolpopexy, facilitating precise dissection and mesh management in the operative field. OBJECTIVE: The objective of our video is to review the treatment options, intraoperative evaluation, and techniques for sacrocolpopexy revision. METHODS: Our patient is a 55-year-old female who presented with recurrent prolapse. She had a past surgical history of supracervical hysterectomy with sacrocolpopexy 13 years ago. After reviewing the various treatment options, the patient elected to proceed with a robot-assisted laparoscopic sacrocolpopexy revision. Upon evaluation of the previous sacrocolpopexy, it was discovered that the sacral arm had broken and the anterior mesh on the vagina was not at the most distal point. RESULTS: To restore her apical suspension, the sacral arm was reattached to itself and a piece of lightweight mesh was used to augment the anterior vagina, as well as the sacral arm. The repair was completed successfully, without complications. The vaginal apex was resuspended, and the anterior vaginal support was improved. CONCLUSIONS: Robotic-assisted laparoscopic sacrocolpopexy revision is a feasible and effective approach for managing recurrent prolapse. Adoption of robotic techniques in urogynecology can optimize anatomical restoration and symptom improvement in appropriately selected patients.