Robot-Assisted Laparoscopic Repair for Recurrence After Robot-Assisted Laparoscopic Sacrocolpopexy: A Case Report

Abstract

A 71-year-old woman with POP-Q stage IV uterine prolapse with cystocele underwent robot-assisted sacrocolpopexy (RSC) using the hinotori Surgical System. During the initial surgery, bleeding from the median sacral vein led to suboptimal mesh fixation at the sacral promontory. Within 1 month post-surgery, the patient experienced recurrence of prolapse symptoms. Examination revealed descent of the uterine cervix to nearly the pre-operative state. Robot-assisted repair surgery was performed, which confirmed detachment of the mesh from the sacral fixation site. The repair involved excising the upper mesh edge, extending it with new mesh, and securing it to the L5–S1 anterior longitudinal ligament. The patient showed no recurrence at the 5-month follow-up. This case emphasizes the need for proper mesh fixation in RSC and demonstrates the feasibility of using robot-assisted surgery to manage early recurrence. Surgeons should be vigilant about potential early recurrence and prepared to offer timely corrective interventions.