Flat versus Y-Mesh Success in Robotic Sacrocolpopexy: A Retrospective Analysis

Objectives: Pelvic organ prolapse (POP) is a prevalent condition among women worldwide, affecting various aspects of daily life. Sacrocolpopexy (SCP) has emerged as a highly effective surgical intervention for POP, often performed with robotic assistance (RSC). This study aims to compare the efficacy of two mesh configurations, Y-mesh and flat mesh, in RSC procedures for the treatment of POP.

Methods: A retrospective cohort study was conducted, including adult women who underwent RSC between April 2021 and January 2023 at an urban community teaching hospital. Data was collected from electronic medical records, including demographic information, preoperative POP-Q evaluation, intraoperative details, and 12-week postoperative follow-up outcomes.

Results: Of the 189 patients analyzed, 88 (52%) received flat mesh, and 82 (48%) received Y mesh. Minimal intraoperative complications were observed, with one case of cystotomy in the Y mesh group. While demographic characteristics showed differences in tobacco use (32% vs. 18%, p=0.04) and parity (2.5 vs. 2.9, p=0.09) between the two groups, subgroup analysis did not demonstrate correlation with RSC success. Preoperative stress urinary incontinence (SUI) was prevalent in both groups, with a high percentage of patients undergoing concurrent mid urethral sling placement.

The primary outcome, RSC success, defined as no retreatment for vaginal bulge symptoms or vaginal wall descent beyond the hymen, did not significantly differ between the flat and Y-mesh groups (93% vs. 95%, p=0.59). Subjective vaginal bulge symptoms were infrequent (3% vs. 0%), and all patients declined retreatment for bulge symptoms. Objective failure did not significantly differ between the two groups (2% vs 3%, p=0.76), nor did retreatment rates.

Conclusions: In conclusion, there was no significant difference in RSC success rates between Y-mesh and flat mesh configurations at the 12-week postoperative visit. These findings contribute to the existing evidence base regarding the choice of mesh configuration in RSC procedures for POP treatment. Both Y-mesh and flat mesh are appropriate for RSC based on surgeon preference and clinical decision-making.