Removal of a sacrocolpopexy sling can be technically challenging. The robotic approach facilitates precise dissection while maintaining a minimally invasive technique. The objective of this video is to demonstrate a robotic technique for sacrocolpopexy mesh removal in the setting of a rectovesical fistula using the Da Vinci X system.

A 66-year-old female presented with overactive bladder symptoms, hematuria, and fecaluria. She had a history of sacrocolpopexy performed several years earlier.
MRI revealed a vertebral disc infection with associated inflammation and thickening of the sling. Cystoscopy and rectoscopy demonstrated mesh exposure involving both the bladder and rectum.

The procedure was performed under general anesthesia using the Da Vinci X robotic system via a transperitoneal approach. Dissection began at the bladder, where the anterior mesh was quickly identified. The bladder was carefully dissected and closed with two running sutures. Leak testing confirmed a watertight closure. Dissection was then continued toward the rectum, where an anterior rectal fistula was identified. The sling was removed from the rectum, and the defect was closed with multiple interrupted Vicryl sutures. The operative time was 360 minutes. The patient resumed bowel function and was discharged on postoperative day 6. The urinary catheter was removed on day 10. At the last follow-up, the patient had no complications and reported marked improvement of symptoms.

The robotic approach provides an effective and minimally invasive option for complex removal of sacrocolpopexy mesh, allowing precise dissection and secure repair of associated rectovesical fistulas.