Intrafascial Colpotomy, Edge-to-Edge Closure, and Peritoneal Graft Technique for Minimizing Mesh Erosion in Concurrent Robotic Hysterectomy and Sacrocolpopexy

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INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy (SCP) is a recognized treatment for apical pelvic organ prolapse (POP). However, mesh erosion remains a concern, particularly when performed with concomitant hysterectomy. This video presents data on one case of a modified technique aimed at potentially minimizing mesh erosion in robotic SCP. METHODS: This technique focuses on reinforcing the vaginal cuff and using a pedicled peritoneal graft to create a tissue barrier between the mesh and the vaginal vault. Procedural steps include intrafascial colpotomy, edge-to-edge cuff closure using barbed sutures, and joining anterior and posterior meshes away from the vaginal cuff. RESULTS: The surgical technique was successfully implemented in this single patient presented in the video and was performed in ten more patients with no intraoperative or postoperative complications. During the follow-up period, there were no signs of mesh erosion or exposure. CONCLUSIONS: This approach emphasizing vaginal cuff strengthening and mesh separation using a pedicled peritoneal graft can be an option for reducing mesh erosion risk. This report does not provide definitive evidence that this approach reduces mesh erosion risk and further research and long-term follow-up are required to validate these findings and integrate this technique into standard management practices.

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