Robotic sacral colpopexy (RSC) is rapidly emerging as a safe and effective approach for the treatment of advanced stage pelvic organ prolapse. The operation can be performed with either mesh or autologous fascia lata. The use of autologous fascia lata during RSC has previously been described as a safe option with rare apical prolapse recurrences and complications mainly related to fascia harvest including seroma, DVT [1,2]. Mesh is considered to be the gold standard option with low prolapse recurrence rates and complications mainly related to mesh erosion[3]. The hypothesis is that fascia lata will provide non-inferior prolapse outcomes with no risk of mesh erosion.

We performed a single-institution, institutional review board approved analysis of patients enrolled in a prospective non-randomized trial to undergo RSC from November 2017- December 2019. Patients were offered mesh or autologous fascia lata. No patients were excluded from the study. Patient data were extracted from medical records and patient surveys. Data analyzed included preoperative factors, operative timing, postoperative hospital stay, and complications, Pelvic Organ Prolapse Quantification (POP-Q) exam, and patient reported outcomes including Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Failure was defined as POP-Q stage 2 or greater in any compartment.

A total of 64 patients underwent RSC during this timeframe; 19 (29.7%) elected to undergo fascia lata RSC and 45 (70.3%) elected to undergo mesh RSC. At the time of surgery, all patients had ≥2cm apical descent with median POP-Q stage of 3.  Nine of 19 (31.6%) underwent hysterectomy in the fascia lata group while 19/45 (42.2%) underwent hysterectomy in the mesh group.  Patient-reported and anatomic outcomes appear in Figure 1. The average operative time was 289 ±39 minutes for fascia lata with harvest time average of 25 ±7.4 minutes. The average operative time for mesh was 237 ±39 minutes. The average hospital stay for both groups was 1.5 ±0.5 days. There were two failures in the fascia lata group (10%) with one apical and one anterior compared to two failures (4%) in the mesh group both occurring in the posterior compartment at an average follow-up of 10.7 ±9.1 months.  The difference was not significant (p=0.36).  In the fascia lata group, the most significant complications included one hematoma at harvest site requiring transfusion and one ipsilateral DVT. In the mesh group, one mesh erosion was noted.

There were significant improvements in patient-reported outcomes and POP-Q exams for both groups with a failure rate in the fascia lata group that was not significant as seen in Figure 1. The average operative time including harvest was longer for fascia lata.  The complication rates associated with both methods were low, but differed in nature.

This is the first prospective comparison of fascia lata to mesh during RSC. Overall fascia lata RSC appears to have comparable short term failure rates to mesh RSC and low numbers of complications related to fascia harvest, without the risk of mesh erosion. A longer-term randomized controlled trial is necessary to further compare these two options.   Instructive video describing the technique has been published [1].

Isamu Tachibana, Mark Pickhardt, C.R. Powell. Robotic Sacral Colpopexy with Fascia Lata for Pelvic Organ Prolapse. Videourology  VOL. 33, NO. 3. Published Online: 4 Jun 2019  https://doi.org/10.1089/vid.2019.0007
Scott V, Oliver J, Raz S, Kim JH. Robot-assisted sacral colpopexy with autologous fascia lata: Technique and initial outcomes. International Urogynecology. 2019: 30 (11): 1965-1971. Doi:10.1007/s00192-019-03884-2.
CR Powell, I Tachibana, B Eckrich, J Rothenberg, J Hathaway. Robotic Sacral Colpopexy. Journal of endourology. 32 (S1), S-111-S-116. 2018.