What Is Sacrocolpopexy?

Sacrocolpopexy is a surgery that treats apical prolapse — when the top of the vagina (or the uterus) drops down — by anchoring the vaginal apex to the sacrum (the tailbone area) with a small piece of lightweight mesh. The result is a stable, well-supported vaginal apex that does not sag into the vagina.

Robotic sacrocolpopexy performs this operation through several small (5–12 mm) abdominal incisions using the da Vinci surgical robot. The robot allows 3D vision, fine instrument control, and improved precision over traditional laparoscopy.

Why It Is the Gold Standard

Sacrocolpopexy has the highest long-term anatomic success rate of any apical prolapse repair. It is especially well-suited for younger, active women and for those with severe or recurrent prolapse. For context, see our Pelvic organ prolapse guide.

Who Is a Candidate?

Ideal Candidates

  • Symptomatic apical prolapse — vaginal vault or uterine prolapse
  • Advanced Stage 3–4 prolapse
  • Recurrent prolapse after a prior vaginal repair
  • Younger, active women who want the most durable repair
  • Can safely undergo abdominal surgery

May Not Be Ideal For

  • Significant medical comorbidities limiting abdominal/robotic surgery
  • Extensive prior abdominal surgery or severe adhesions
  • Patients wanting to avoid any mesh
  • Patients preferring a single-day vaginal repair — SSLF is a good alternative

How the Procedure Works

Robotic sacrocolpopexy is performed under general anesthesia through small (5–12 mm) abdominal incisions. The uterus is usually removed at the same time (supracervical hysterectomy preserves the cervix, which helps lower the risk of mesh exposure), though the uterus can sometimes be preserved.

The Steps

  • Anesthesia: general
  • Access: 4–5 small abdominal incisions for the robot and assistant
  • Hysterectomy (if done): supracervical (cervix preserved) is typical
  • Dissection: the vaginal apex and the anterior sacral surface are exposed
  • Mesh: a Y-shaped lightweight polypropylene mesh is secured to the front and back of the upper vagina
  • Suspension: the stem of the Y is anchored to the anterior longitudinal ligament at the sacrum without tension
  • Peritoneal closure: mesh is covered with peritoneum to reduce bowel contact
  • Cystoscopy: confirms bladder and ureter integrity

At-a-Glance

  • Duration: 2.5–4 hours
  • Incisions: 4–5 small (5–12 mm)
  • Hospital stay: outpatient or 1-night observation
  • Catheter: typically overnight
  • Often combined with: supracervical hysterectomy, anterior/posterior repair as needed, midurethral sling if indicated

Success & Durability

Outcome Result
Anatomic apical success 90–95% at 5 years
Symptom resolution Very high patient satisfaction
Mesh exposure risk ~1–3% (lower with cervix preservation)
Return to normal activity 4–6 weeks
Need for re-operation Low — lowest of any apical repair

Recovery

Hospital to Home

  • Outpatient or 1-night hospital stay
  • Catheter typically removed before discharge or at your first follow-up
  • Diet advanced as tolerated

Week 1

  • Mild to moderate abdominal soreness; controlled with oral medications
  • Walk frequently; avoid heavy lifting (>10 lbs)
  • Some shoulder discomfort from the gas used during surgery is normal and resolves within a few days

Weeks 2–6

  • Gradual return to light daily activities and desk work
  • No intercourse, tampons, or swimming until cleared (typically 6 weeks)
  • Follow-up exam to confirm healing

Beyond 6 Weeks

  • Resume full exercise and sexual activity
  • Maintain bowel regularity, cough control, and a healthy weight to protect the repair

Risks & Potential Complications

  • Mesh exposure/erosion (1–3%) — small areas of mesh visible through the vaginal wall; usually managed in the office or with a small outpatient revision
  • Bladder or ureter injury — rare; identified and repaired at surgery
  • Bowel injury — rare
  • Bleeding — rare; transfusion is uncommon
  • New-onset stress urinary incontinence — addressed with a concurrent or later sling
  • Urinary retention — short-term in a small percentage
  • Back pain or de novo pelvic pain — uncommon
  • Conversion to open surgery — extremely rare

Sacrocolpopexy vs. Sacrospinous Ligament Fixation

Feature Robotic Sacrocolpopexy Sacrospinous Ligament Fixation
Approach Abdominal (robotic) Vaginal
Mesh Yes — abdominal No — native-tissue
Anatomic durability (apex) 90–95% at 5 years 80–90%
Surgery time Longer Shorter
Hospital stay Outpatient or 1 night Outpatient or 1 night
Best for Younger/active, severe/recurrent Mesh-free preference, combined vaginal repairs

Frequently Asked Questions

Is this mesh safe?

The mesh used in sacrocolpopexy is placed abdominally — not transvaginally — and has decades of safety data. The FDA concerns you may have seen relate specifically to transvaginal mesh for prolapse, which is a different procedure and is no longer used.

Will my uterus be removed?

Usually yes — a supracervical hysterectomy is performed at the same operation, preserving the cervix to lower the risk of mesh exposure. In selected cases the uterus can be preserved (sacrohysteropexy).

How long until I can return to work?

Most patients with desk jobs return in 2–3 weeks. Jobs with heavy lifting require 6 weeks off.

Can I have sex normally after?

Yes. The repair preserves vaginal length and often improves sexual comfort by relieving the bulge.

Is this covered by insurance?

Yes. Robotic sacrocolpopexy is covered by most insurance plans including Medicare. Our team will verify your coverage.

Durable Support, Minimally Invasive

If you are dealing with advanced or recurrent apical prolapse, robotic sacrocolpopexy offers the most durable repair available, using a minimally invasive approach. Our surgeons are high-volume robotic specialists in pelvic reconstruction.

  • ✅ Small incisions, robotic precision
  • ✅ Highest long-term success rates
  • ✅ Outpatient or 1-night hospital stay
  • ✅ Combined hysterectomy and additional repairs when needed
Schedule Your Consultation

Call 678-344-8900 to speak with our team