A Novel Mesh Reattachment Technique in Revision Sacrocolpopexy

Objectives: The aim of this video is to demonstrate surgical considerations and techniques for revision sacrocolpopexy after acute symptomatic apical recurrence.

Methods: In this video, we show a patient with acute symptomatic apical prolapse following index sacrocolpopexy. We demonstrate techniques for robotic-assisted laparoscopic sacrocolpopexy revision, focusing on safe surgical dissection. We present a novel approach to vaginal mesh attachment in which we attach new mesh arms to the vaginal apex and connect them to the original mesh.

Clinical Relevance: This provides guidance on management of symptomatic apical recurrence after sacrocolpopexy, a rare surgical outcome. Reoperation can be challenging due to altered anatomy from prior pelvic surgery and each patient requires an individualized approach. In this case, leaving the prior mesh in situ reduced potential morbidity and enhanced repeat prolapse repair.