Combined corrective surgery for multi-compartment prolapse can optimize the anatomic position of pelvic organs and reduce the need and costs of a second surgery. Concomitant sacrocolpopexy (SCP) and ventral rectopexy (VRP) has been described as an effective approach for treating rectal and vaginal prolapse with improvements in quality of life and bowel function. However, approaches in mesh application vary in the literature. In our video, we will demonstrate our technique using a single polypropylene Y mesh.

We report a case of a 60 year-old female with multi-compartment pelvic organ prolapse including a large stage 3 posterior prolapse with obstructive defecatory symptoms. We demonstrate the key steps and techniques used in a combined robotic assisted sacrocolpopexy and ventral mesh rectopexy using a single polypropylene Y-mesh.

Mesh preparation is described along with key steps which include: 1. Dissection of presacral space down to the pelvic floor 2. Dissection of rectovaginal septum down to the perineal body 3. Exposure of anterior longitudinal ligament and pre-placement of non-absorbable sutures 4. Dissection of vesicovaginal space 5. Suture fixation of Y-mesh onto anterior vaginal wall 6. Suture fixation of Y-mesh onto entire length of posterior vaginal wall 7. Suture fixation of Y-mesh onto anterior wall of lower rectum 8. Tensioning and fixation of mesh tail onto anterior longitudinal ligament 9. Closure of peritoneum over the entire mesh 10. Cystoscopy

The patient did well post-operatively and was discharged on the same day. At the one month follow-up, she reported significantly improved defecatory symptoms. Pelvic exam revealed a well-healed vaginal canal without recurrent prolapse or exposed mesh. Combined robotic-assisted sacrocolpopexy and ventral rectopexy using a single mesh is an effective treatment for multi-compartment prolapse and obstructed defecation syndrome. By performing concomitant surgery, patients can avoid the costs and risks of undergoing a second operation.

Continence 19S (2026) 102595
DOI: 10.1016/j.cont.2026.102595