Pelvic organ prolapse (POP) is a common problem among women. The surgical repair of POP continues to evolve from the traditional transvaginal suture repair to open mesh sacrocolpopexy to minimally invasive techniques of laparoscopy and Robotic sacrocolpopexy. Abdominal sacrocolpopexy (ASC) is considered to be the gold standard treatment for vaginal vault prolapse. Numerous studies have shown this procedure to have high success rates (78–100%) and long-term durability. The procedure is associated with significantly less recurrent prolapse when compared to vaginal reconstruction procedures. (1) Despite its rising adoption, Robot assisted sacrocolpopexy (RSCP) has not been fully standardized yet.(2)

A 46 year lady presented with complaint of something coming out per vagina associated with voiding Lower urinary tract symptoms since 5 years. Patient had past history of Total abdominal hysterectomy 10 years back in view of abnormal uterine bleeding. Patient was subsequently diagnosed as Stage 4 Vault prolapse and planned for Robot assisted sacrocolpopexy.

We aim to provide 10 commandments of RSCP with few tips and tricks which might improve postoperative outcomes in patients.  
We prefer using single mesh hand shaped in Y configuration by the surgeon. Synthetic polypropylene mesh has shown durable results with minimum risk of mesh erosion. (3)
Posterior and anterior dissection was done close to vagina and posterior limb of mesh is sutured distally to posterior vaginal wall to lift mesh closure to vagina and thus avoiding interference with rectum avoids postoperative bowel dysfunction. (2) 
Mesh is placed fixed over anterior and posterior vaginal wall while avoiding breaching the vaginal mucosa for a length of 4-6cm using 3-4 sutures only and stitches to vault is avoided to avoid breaching mucosa at apex.
Closure of peritoneum is done to avoid contact of bowel with prolene mesh however several studies have proposed no significant risk of adhesions and bowel obstruction, if mesh is not retroperitonealised. (3)
Postoperative period was uneventful with patient voiding normally post catheter removal. Post 1 month follow up patient is voiding normally without prolapse.

Robotic assisted sacrocolpopexy enables the successful correction of Vault prolapse with preservation of vaginal length and minimal complications.

Hudson CO, Northington GM, Lyles RH, Karp DR. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2014 Sep-Oct;20(5):252-60.
Li Marzi V, Morselli S, Di Maida F, Musco S, Gemma L, Bracco F, Tellini R, Vittori G, Mari A, Campi R, Carini M, Serni S, Minervini A. Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up. Ther Adv Urol. 2022 Apr 21; 14:17562872221090884.
Gilleran JP, Johnson M, Hundley A. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010 Oct;2(5-06):195-208