We present the case of complete recurrence of vaginal vault prolapse after minimally invasive sacrocopalpexy, which was managed with robotic-assisted removal of the previous mesh and placement of a new sacrocopalpexy mesh. The patient is a 64-year-old who presented with a 15-year history of recurrent stage or vaginal vault prolapse following a laparoscopic sacrocopalpexy posterior repair and perineurophy. Upon entering to the abdominal cavity, the mesh was noted to be attached to the right pelvic sidewall with adhesions to the sigmoid colon and the small bowel. The sacrum was attached to the sacrum, however, there were no vaginal attachments remaining. The sacral arm of the mesh was identified and detached from the sacrum. Two separate proline sutures were identified and transected. The mesh was then detached from the pelvic sidewall. Multiple metal staples were noted, implying that they were used to anchor the mesh to the vagina. Finally, the mesh was detached from the sigmoid colon and the small bowel. The small bowel was noted to be partially ingrown into the mesh. As a result, a small bowel serosal defect was oversewn with 3L PDS. Next, we exposed the anterior longitudinal ligament at the level of a swan. The proline sutures were noted to be attached to a metallic laparoscopic suture anchor. One of the suture anchors was removed. The second one was too deep in the periosteum and was not able to be removed. The sutures attached to the suture anchor were cut. Vaginal dissection was performed in preparation for new mesh placement. Posterior dissection of the rectovaginal space was performed first. Dissection was carried down to the level of the perineal body. The vesicovaginal space was entered sharply and dissected down to the level of the bladder neck. The new mesh was then introduced into the abdominal cavity and attached to the posterior and anterior vagina as well as the sacrum using CV4 cortex sutures. The peritoneum overlying the mesh was then re-approximated using a 2L monocle suture. All mesh remnants were removed from the abdomen using an endocatch bag. Here are the previous mesh and the laparoscopic suture anchor. The patient did well postoperatively and was discharged home on postoperative day number 1. It has now been 5 months since her surgery and she reports complete resolution of her prolapse. For more information visit www.osho.com

recurrent vaginal vault prolapse

sacrocopalpexy repair

robotic-assisted mesh removal

new mesh placement

successful recovery