Design: Retrospective case series

Setting: An Academic-affiliated community hospital

Patients or Participants: Between January 2012 and April 2024, a total of 1601cases underwent robotic-assisted sacrocolpopexy procedures for pelvic organ prolapse by a single urogynecologist. A total of (N=12) patients presented with recurrent POP symptoms after a previous sacrocolpopexy and underwent a sacrocolpopexy revision surgery

Interventions: Robotic sacrocolpopexy revision

Measurements and Main Results:

The median age of the patients who underwent the primary SCP was 55.7 and 70% of them were under the age of 60. The median interval between the primary and revision procedures was 7 years. The mean operative time of the revision procedure was 168.3 minutes. There were no conversions to laparotomy. During the revision procedures, mesh failure was identified as follows; long arm of the mesh (between the vagina and sacrum) stretch was recognized in 4 cases, avulsion from the vagina in 4 patients, while avulsion from the sacrum was seen in 2 cases. Complete disruption of the mesh was identified in one case, where the long arm of the mesh was completely transected between the sacrum and vagina. During the revision SCP, a new full-length Y mesh was introduced in 83% of the cases while only a partial piece of the Y mesh in 17 %. There were no complications in any of the revision cases.

Conclusion:

Robotic Sacrocolpopexy Revision is a safe surgery, with minimal blood loss and no complications encountered in our case series. The site of mesh failure is variable. Sacrocolpopexy failure can be impacted by multiple factors including the original extent of dissection and mesh attachment as well as the type of mesh among others. Our study further highlights the need for standardization and classification of the sacrocoplpopexy procedure for better analysis and comparison of outcomes