Robotic Abdominal Sacrocolpopexy

  • Sarah McAchranEmail author
  • Courtenay K. Moore


Abdominal sacrocolpopexy with synthetic mesh is a gold-standard technique for the repair of vaginal prolapse; however, the need for general anesthesia, longer operative time, and increased invasiveness compared with vaginal approaches limit its use. The addition of robotic technology is appealing to both the patient and the surgeon as a minimally invasive alternative with acceptable morbidity and complication rates. This chapter briefly reviews the indications and contraindications for repair and focuses on the technical aspects of the procedure. The current outcomes and complications literature are reviewed.


Robotic sacrocolpopexy Pelvic organ prolapse 


  1. 1.
    Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, Zyczynski H, Pelvic Floor Disorders Network. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Nezhat CH, Nezhat F, Nezhat C. Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gynecol. 1994;84(5):885–8.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol. 2005;192(5):1752–8.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Klauschie JL, Suozzi BA, O’Brien MM, McBride AW. A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(3):273–9.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC. Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol. 2007;21(8):926–30.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Geller EJ, Parnell BA, Dunivan GC. Robotic vs abdominal sacrocolpopexy: 44-month pelvic floor outcomes. Urology. 2012;79(3):532–6.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Anand M, Weaver AL, Fruth KM, Trabuco EC, Gebhart JB. Symptom relief and retreatment after vaginal, open, or robotic surgery for apical vaginal prolapse. Female Pelvic Med Reconstr Surg. 2017;23(5):297–309.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, et al. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg. 2009;109(2):473–8.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Brizzolara S, Pillai-Allen A. Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Obstet Gynecol. 2003;102(2):306–10.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Cundiff GW, Varner E, Visco AG, Zyczynski HM, Nager CW, Norton PA, Pelvic Floor Disorders Network, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5.CrossRefGoogle Scholar
  13. 13.
    Wu JM, Wells EC, Hundley AF, Connolly A, Williams KS, Visco AG. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy. Am J Obstet Gynecol. 2006;194(5):1418–22.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Quiroz LH, Gutman RE, Fagan MJ, Cundiff GW. Partial colpocleisis for the treatment of sacrocolpopexy mesh erosions. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(2):261–6.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    South MM, Foster RT, Webster GD, Weidner AC, Amundsen CL. Surgical excision of eroded mesh after prior abdominal sacrocolpopexy. Am J Obstet Gynecol. 2007;197(6):615.e1–5.CrossRefGoogle Scholar
  16. 16.
    Kho RM, Akl MN, Cornella JL, Magtibay PM, Wechter ME, Magrina JF. Incidence and characteristics of patients with vaginal cuff dehiscence after robotic procedures. Obstet Gynecol. 2009;114(2 Pt 1):231–5.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Matthews CA, Carroll A, Hill A, Ramakrishnan V, Gill EJ. Prospective evaluation of surgical outcomes of robot-assisted sacrocolpopexy and sacrocervicopexy for the management of apical pelvic support defects. South Med J. 2012;105(5):274–8.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Woods DL, Hou JY, Riemers L, Gupta D, Kuo DY. Side-docking in robotic-assisted gynaecologic cancer surgery. Int J Med Robot. 2011;7(1):51–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Einarsson JI, Hibner M, Advincula AP. Side docking: an alternative docking method for gynecologic robotic surgery. Rev Obstet Gynecol. 2011;4(3–4):123–5.PubMedPubMedCentralGoogle Scholar
  20. 20.
    McCullough M, Valceus J, Downes K, Hoyte L. The ureter as a landmark for robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(3):162–4.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Mitchell CR, Gettman M, Chow GK, Elliott D. Robot-assisted sacrocolpopexy: description and video. J Endourol. 2012;26(12):1596–9.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Rosenblum N. Robotic approaches to prolapse surgery. Curr Opin Urol. 2012;22(4):292–6.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Akl MN, Long JB, Giles DL, Cornella JL, Pettit PD, Chen AH, Magtibay PM. Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc. 2009;23(10):2390–4.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Belsante M, Murray S, Dillon B, Zimmern P. Mid term outcome of robotic mesh sacrocolpopexy. Can J Urol. 2013;20(1):6656–61.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Kramer BA, Whelan CM, Powell TM, Schwartz BF. Robot-assisted laparoscopic sacrocolpopexy as management for pelvic organ prolapse. J Endourol. 2009;23(4):655–8.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Moreno Sierra J, Ortiz Oshiro E, Fernandez Pérez C, Galante Romo I, Corral Rosillo J, Prieto Nogal S, et al. Long-term outcomes after robotic sacrocolpopexy in pelvic organ prolapse: prospective analysis. Urol Int. 2011;86(4):414–8.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Robotic-assisted and laparoscopic sacrocolpopexy: comparing operative times, costs and outcomes. Female Pelvic Med Reconstr Surg. 2011;17(1):44–9.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol. 2006;176(2):655–9.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Ploumidis A, Spinoit AF, De Naeyer G, Schatteman P, Gan M, Ficarra V, et al. Robot-assisted sacrocolpopexy for pelvic organ prolapse: surgical technique and outcomes at a single high-volume institution. Eur Urol. 2014;65(1):138–45.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol. 2012;206(5):435.e1–5.CrossRefGoogle Scholar
  31. 31.
    Mueller MG, Jacobs KM, Mueller ER, Abernethy MG, Kenton KS. Outcomes in 450 women after minimally invasive abdominal sacrocolpopexy for pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2016;22(4):267–71.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Gupta P, Ehlert M, Bartley J, Gilleran J, Killinger KA, Boura JA, et al. Perioperative outcomes, complications, and efficacy of robotic-assisted prolapse repair: a single institution study of 196 patients. Female Pelvic Med Reconstr Surg. 2018;24(6):408–11.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Kenton K, Mueller ER, Tarney C, Bresee C, Anger JT. One-year outcomes after minimally invasive sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(5):382–4.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547.e1–8.CrossRefGoogle Scholar
  35. 35.
    Anand M, Woelk JL, Weaver AL, Trabuco EC, Klingele CJ, Gebhart JB. Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse. Int Urogynecol J. 2014;25(9):1193–200.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Vahanian SA, Finamore PS, Lazarou G. Delayed small bowel obstruction after robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2015;21(1):e11–3.PubMedCrossRefGoogle Scholar
  37. 37.
    Feng TS, Thum DJ, Anger JT, Eilber KS. Sacral osteomyelitis after robotic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(1):e6–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Boyd B, Pratt T, Mishra K. Fungal lumbosacral osteomyelitis after robotic-assisted laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2018;24(6):e46–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Apostolis CA, Heiselman C. Sacral osteomyelitis after laparoscopic sacral colpopexy performed after a recent dental extraction: a case report. Female Pelvic Med Reconstr Surg. 2014;20(6):e5–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Grimes CL, Tan-Kim J, Garfin SR, Nager CW. Sacral colpopexy followed by refractory Candida albicans osteomyelitis and discitis requiring extensive spinal surgery. Am J Obstet Gynecol. 2012;120(2 Pt 2):464–8.CrossRefGoogle Scholar
  41. 41.
    Iavazzo C, Gkegkes ID. Osteomyelitis after robotically assisted laparoscopic sacral colpopexy. Acta Inform Med. 2013;21(2):143.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Muffly TM, Diwadkar GB, Paraiso MF. Lumbosacral osteomyelitis after robot-assisted total laparoscopic hysterectomy and sacral colpopexy. Int Urogynecol J. 2010;21(12):1569–71.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Linder BJ, Anand M, Klingele CJ, Trabuco EC, Gebhart JB, Occhino JA. Outcomes of robotic sacrocolpopexy using only absorbable suture for mesh fixation. Female Pelvic Med Reconstr Surg. 2017;23(1):13–6.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Linder BJ, Occhino JA, Habermann EB, Glasgow AE, Bews KA, Gershman B. A national contemporary analysis of perioperative outcomes of open versus minimally invasive sacrocolpopexy. J Urol. 2018;200(4):862–7.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA

Personalised recommendations