Critical Anatomy for Robotic Sacrocolpopexy: A Long-term Follow-up Study

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery
• Surgical anatomy

Background:

• Robotic sacrocolpopexy is a surgical procedure to treat pelvic organ prolapse.
• Assessing long-term anatomical changes after robotic sacrocolpopexy is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the anatomical changes relative to sacral sutures 20 to 24 months after robotic sacrocolpopexy.
• To assess the stability of vascular and urologic structures and the distance from the vaginal apex to the sacral suture over time.

Main Methods:

• Prospective anatomy study involving women undergoing robotic sacrocolpopexy.
• Placement of a vascular clip on sutures attached to the anterior longitudinal ligament.
• Postoperative imaging at 6 weeks and 20-24 months for anatomical measurements.

Main Results:

• Vascular anatomy and the right ureter's position remained stable relative to the clip.
• A significant increase in the distance from the vaginal apex to the sacral suture was observed (from 69.3 mm at 6 weeks to 85.2 mm at 20-24 months, P = 0.004).

Conclusions:

• While vascular landmarks are stable, the increase in vaginal apex distance suggests mesh or vaginal tissue elongation over time.
• This finding may have clinical relevance, guiding surgeons on appropriate mesh tensioning during robotic sacrocolpopexy.