Sacrocolpopexy (robotic mesh prolapse repair)

Keyhole robotic surgery that lifts a sagging vagina, along with the bladder and bowel that sag with it, back into place and holds it there with a strip of soft surgical mesh attached to the sacrum, the bone at the base of the spine. It is one of the longest-lasting repairs for prolapse of the top of the vagina or the uterus.

Also called robotic sacrocolpopexy, laparoscopic sacrocolpopexy, abdominal sacrocolpopexy, sacrohysteropexy, vaginal vault prolapse repair, vault suspension, colpopexy, pelvic organ prolapse repair

Where: Hospital operating room
Anesthesia: General anesthesia
Time in the room: About 2 to 4 hours, longer if a hysterectomy is done at the same time
Hospital stay: Same day or one night
Going home with: Usually none. A few women go home with a catheter for a few days if the bladder is slow to empty.
Back to normal: About 2 to 4 weeks for daily life; about 6 weeks before heavy lifting
Back to work: About 2 to 4 weeks for desk work; about 6 weeks for physical work

See the steps

VaginaBladderRectumTailbone (sacrum)Pelvic floor muscles

Where it happens. The highlighted part is what this procedure treats.

Overview

Pelvic organ prolapse happens when the support tissues of the pelvis stretch or tear, often after childbirth and with aging, and the vagina sags downward. The bladder, the uterus, the top of the vagina, or the rectum can bulge into or out of the vaginal opening. Women describe a bulge, pressure, a feeling of sitting on a ball, trouble emptying the bladder or bowel, or discomfort with sex. Prolapse is common and is not dangerous in itself. Treatment depends on how much it bothers you.

Sacrocolpopexy lifts the top of the vagina and attaches it with a Y-shaped strip of lightweight mesh to a strong ligament on the front of the sacrum, the bone at the base of the spine. The mesh acts like a new suspension ligament. Because the mesh is attached along the front and back walls of the vagina, it also supports the bladder and the rectum.

Most sacrocolpopexies in the United States are now done robotically through 5 or 6 small cuts on the belly. The operation is usually done by a urogynecologist or a urologist who specializes in female pelvic medicine. If you still have a uterus, it may be removed at the same time, often leaving the cervix, or it may be kept and lifted with the mesh (sacrohysteropexy).

About mesh: in 2019 the U.S. Food and Drug Administration (FDA) ordered companies to stop selling mesh designed to be placed through the vagina to repair prolapse. That order did not cover mesh placed through the belly for sacrocolpopexy, which remains available and is supported by long-term studies. It also did not cover mesh slings for stress leakage. Your surgeon should explain the specific risks of the mesh used in your operation.

The parts of your body involved

The vagina is held in place by ligaments and connective tissue at its top (the apex) and along its sides, and by the pelvic floor muscles below. After a hysterectomy, the top of the vagina is called the vaginal cuff or vault. When the top support fails, the vault drops and often pulls the bladder (in front) and the rectum (behind) down with it. The sacral promontory, the top front edge of the sacrum, has a strong ligament that can safely hold stitches, which makes it the anchor point for this repair. Large blood vessels and the right ureter lie close to it, so the surgeon works carefully there.

Vagina and vaginal vault
The vault is the top of the vagina. When its support fails, it drops toward or past the opening.
Bladder
Sits in front of the vagina. When it sags into the front wall, this is called a cystocele.
Rectum
Sits behind the vagina. When it bulges into the back wall, this is called a rectocele.
Uterus and cervix
If you still have them, they may be part of the prolapse.
Sacrum and sacral promontory
The bone at the base of the spine. The mesh is anchored to the strong ligament on its upper front edge.
Pelvic floor muscles
The muscular hammock that supports the pelvic organs from below.

Why it’s done

Surgery is one option for prolapse that bothers you. Your surgeon may suggest sacrocolpopexy when the top of the vagina or the uterus has dropped, especially if you are active, have had prolapse come back after an earlier repair, or want the most durable repair. Guidance from the American College of Obstetricians and Gynecologists (ACOG) and the American Urogynecologic Society (AUGS) notes that sacrocolpopexy has a lower chance of prolapse coming back than vaginal repairs using your own tissue, with a longer operation and some mesh-related risks.

A bothersome bulge
Pressure, a visible or felt bulge, or the need to push the bulge back to urinate or move your bowels.
Trouble emptying the bladder or bowel
A sagging vagina can kink the urethra or trap stool, making it hard to empty fully.
Prolapse that has come back
Sacrocolpopexy is often chosen after an earlier repair has failed.
A durable repair for an active life
It is among the longest-lasting prolapse repairs.
Keeping vaginal length
The repair keeps the vagina at a natural length and angle, which matters if you want to remain sexually active.

Other options

Watching and waiting
Prolapse is not dangerous for most women. If it does not bother you, you can leave it alone and have it checked if symptoms change.
Pelvic floor physical therapy
Exercises with a pelvic floor physical therapist can ease symptoms of mild prolapse and may keep it from getting worse.
Vaginal pessary
A soft silicone device placed in the vagina to hold the organs up. It can work well for many women and avoids surgery, but needs regular cleaning and checks.
Vaginal repair with your own tissue
The top of the vagina is stitched to strong ligaments in the pelvis through the vagina, without mesh. A shorter operation and recovery, with a somewhat higher chance of the prolapse coming back.
Colpocleisis (closing the vagina)
For women who no longer want vaginal intercourse, the vagina is narrowed and closed. It is a shorter operation with very high success.

In the operating room, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

YouAnesthesia teamRobotic arms

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1. Anesthesia and positioning

You go to sleep under general anesthesia. Your legs rest in soft stirrups, your arms are tucked at your sides, and the table is tilted head-down so the bowel slides up out of the pelvis. A catheter is placed in the bladder.

You go to sleep under general anesthesia. Your legs rest in soft stirrups, your arms are tucked at your sides, and the table is tilted head-down so the bowel slides up out of the pelvis. A catheter is placed in the bladder.
The surgeon makes 5 or 6 small cuts across the belly, each less than half an inch to about an inch long. The belly is gently filled with carbon dioxide gas to make room to work. Surgeons call this gas-filled space a pneumoperitoneum. It is kept at a gentle pressure, usually 12 to 15 mmHg, and it is what gives the camera and instruments room to move.
The robot's arms are attached to the ports. The surgeon sits at a console nearby and controls the instruments while viewing a magnified 3D image. An assistant stays at your side.
If a hysterectomy is planned, the uterus is removed first, often leaving the cervix in place, which lowers the risk of mesh problems. It is taken out inside a protective bag through a small cut or through the vagina. Some women keep the uterus, and the mesh is attached to the cervix instead.
The thin lining over the sacral promontory is opened. The surgeon identifies the large blood vessels and the right ureter nearby and keeps clear of them. The opening is extended down the right side of the pelvis toward the vagina, to make a path for the mesh.
A tool placed in the vagina pushes it upward. The surgeon gently separates the bladder from the front wall of the vagina and the rectum from the back wall, making space for the mesh.
A Y-shaped piece of soft, lightweight mesh is brought in. Its two arms are laid flat on the front and back walls of the vagina and fixed with several stitches into the wall, without passing through the vaginal lining.
More detail
Modern sacrocolpopexy mesh is a lightweight, wide-pore polypropylene that lets tissue grow into it. The stitches are permanent or slowly dissolving, depending on the surgeon.
The tail of the mesh is brought up to the sacral promontory. The surgeon sets the tension so the vagina sits in a natural position, supported without being pulled tight, and fixes the mesh to the ligament with permanent stitches or small tacks.
The lining of the pelvis is closed over the mesh so the bowel does not touch it.
The robot is undocked. The surgeon looks inside the bladder with a cystoscope to make sure it was not injured and that urine flows from both ureters.
If you have stress leakage, a sling may be placed under the urethra through a small vaginal cut. Some women also need a repair at the vaginal opening or the back wall, done through the vagina.
The gas is let out and the small cuts are closed with dissolving stitches and skin glue. Some surgeons place gauze packing in the vagina overnight. The catheter usually stays until later that day or the next morning.

Your surgeon is in control the whole time

The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.

A magnified 3D view

A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.

Wristed instruments through keyholes

The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.

A team at your side

A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.

After the operation

Right afterward

Waking up
You may feel sore in the belly and have shoulder-tip pain from the gas. Both ease within a few days.
The voiding trial
Before the catheter comes out for good, the bladder is filled and you urinate to show it empties well. If it does not, you go home with a catheter for a few days. This is common and temporary.
Eating
You can usually eat a normal diet the same day.
Walking
You walk the same day or the next morning, which helps prevent clots and speeds recovery.
Pain control
Acetaminophen and ibuprofen on a schedule, with a small supply of stronger medicine if needed.
Going home
Most women go home the same day or the next day.

At home

Pain
Belly and shoulder soreness improve over the first week. A dull ache in the pelvis or low back can last a little longer.
Incisions
Keep the small cuts clean and dry. You can shower the next day. No baths, hot tubs, or swimming until your surgeon clears you, often at about 4 to 6 weeks.
Vaginal spotting
Light bleeding or discharge can come and go for several weeks as stitches dissolve. Use pads, not tampons.
Bowels
Avoid constipation and straining. Take a stool softener, drink plenty of fluids, eat fiber, and consider a footstool under your feet on the toilet.
Bladder
Take your time when you urinate. If you feel you are not emptying, lean forward or stand up and try again.
Activity and lifting
Walk every day. Many surgeons advise avoiding heavy lifting (more than about 10 to 15 pounds) and strenuous exercise for about 6 weeks. Some are less strict, so follow your own surgeon's advice.
Driving
You can drive once you are off opioid pain medicine and can brake hard without pain, often after 1 to 2 weeks.
Sex
Nothing in the vagina (no sex or tampons) for about 6 weeks, until your surgeon checks the healing.
Work
Most women return to desk work in 2 to 4 weeks, and to physical work in about 6 weeks.
Follow-up
Visits at a few weeks and about 6 weeks, then usually a yearly exam that includes checking the vagina for any mesh showing through.

Recovery timeline

Day 0
Surgery
Robotic surgery and recovery. Some women go home the same evening.
Day 1
Home
Catheter out after a voiding trial, or home with a catheter for a few days.
Week 1
Resting
Tiredness, some constipation, and gas pains that settle within days.
Weeks 2 to 3
Getting going
Many women drive again and return to desk work.
6 weeks
Check-up
An exam checks healing. Most women are cleared for sex, lifting, and exercise.
3 months
Mostly healed
Most women feel back to normal and no longer notice a bulge.
1 year
Yearly exam
Your surgeon checks support and looks for any mesh showing in the vagina.
Long term
Lasting support
Most repairs hold for many years. Mesh problems can appear years later, so report new bleeding, discharge, or pain.

What it feels like

Many women put off prolapse surgery for years out of embarrassment or worry about mesh. Afterward, the most common reaction is relief that the bulge is gone. Recovery is usually easier than expected, though tiredness and constipation surprise people.

Deciding about mesh
Worry from news stories and lawsuit ads about vaginal mesh.
What helpsAsk your surgeon what kind of mesh they use, where it goes, and what their own complication rates are. The 2019 FDA action concerned mesh placed through the vagina for prolapse.
Waking up
A sore belly, a catheter, and a strange ache in the shoulders from the gas.
What helpsWalking and changing position help the gas pain pass, usually within 1 to 3 days.
The voiding trial
Anxiety about whether you will be able to urinate, and disappointment if you need a catheter for a few days.
What helpsGoing home with a catheter for a short time is common and does not mean anything went wrong.
The first bowel movement
Fear of straining and hurting the repair.
What helpsStool softeners, fluids, and a footstool under your feet make it easier. Do not hold back when you feel the urge.
The first week at home
More tired than you expected, with some spotting and a pulling feeling deep in the pelvis.
What helpsRest, short walks several times a day, and accepting help.
Noticing the bulge is gone
For many women, real relief, and a return of confidence in their body.
What helpsGive your body time. Full healing takes about 3 months.
Getting back to sex
Nervousness about pain or about harming the repair.
What helpsWait until you are cleared, use plenty of lubricant, and go slowly. Vaginal estrogen can help after menopause. Tell your surgeon about any pain.

How well it works

Success means no bothersome bulge and the top of the vagina staying well supported over time. Sacrocolpopexy is among the most durable prolapse repairs. Even so, some prolapse can return over the years, sometimes in a different part of the vagina, and a small number of women need another operation.

Exams
An exam at about 6 weeks and then yearly checks how well the vagina is supported.
Symptoms
No bulge, less pressure, and easier bladder and bowel emptying.
Bladder function
Emptying often improves. Any new leaking with coughing can be treated.
Mesh checks
Your surgeon looks for any mesh showing through the vaginal wall at follow-up visits.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Shoulder and belly pain from the gasMost women

Settles within a few days.

Constipation

From pain medicine, anesthesia, and less activity. Prevent it with softeners and fluids.

Trouble emptying the bladder for a few days

Some women go home with a catheter for a few days. It almost always resolves.

Urinary tract infection

Burning or urgency in the weeks after surgery. Treated with antibiotics.

Less common

New stress leakage

Leaking with coughing or exercise can appear once the bulge is lifted and no longer kinks the urethra. Your surgeon may test for this before surgery and may suggest a sling.

Mesh showing through the vaginaAbout 2 to 10 in 100 women over several years, depending on the study and technique

Part of the mesh can wear through the vaginal wall, causing discharge, spotting, or pain for a partner. It is often treated with vaginal estrogen or a small procedure to trim the mesh. Smoking and removing the whole uterus and cervix at the same time raise the risk.

Prolapse coming back

Support can weaken again over years, sometimes in a different part of the vagina. A small number of women need another operation.

Pain with sex or pelvic pain

Usually improves with time. Tell your surgeon if it does not.

Changes in bowel emptying

Some women have constipation or a feeling of incomplete emptying.

Rare

Injury to the bladder, bowel, or a ureter

Usually recognized and repaired during surgery.

Serious bleeding near the sacrum

Large veins lie close to where the mesh is anchored. Bleeding may need a transfusion or a change to open surgery.

Infection near the sacrum

A rare but serious infection of the bone or disc near the mesh anchor, causing severe low back pain and fever.

Mesh wearing into the bladder or bowel

Very rare. May need surgery to remove the mesh.

Blood clots in the legs or lungs

Prevented with walking and leg sleeves.

Call your care team or go to the emergency room if

Fever of 101°F (38.3°C) or higher
You cannot urinate, or only dribble, and your bladder feels full
Heavy vaginal bleeding (soaking a pad every hour) or large clots
Belly pain that gets worse instead of better, a swollen belly, or vomiting
Severe low back pain with fever
Redness, swelling, or pus at an incision
Foul-smelling vaginal discharge
Leg swelling or pain, chest pain, or shortness of breath (call 911 for chest pain or trouble breathing)

Questions to ask your surgeon

Which parts of my vagina have dropped, and will sacrocolpopexy fix all of them?
Why do you recommend sacrocolpopexy for me over a vaginal repair or a pessary?
What kind of mesh do you use, and what are its risks?
If I have a uterus, will you remove it, keep it, or leave the cervix?
Do I have hidden stress leakage, and would you add a sling?
How many sacrocolpopexies do you do each year?
What are your rates of mesh exposure and repeat surgery?
Will I go home the same day?
When can I lift, exercise, and have sex again?
If the mesh ever caused problems, how would you treat it?
Could this change my bowel habits?

Words you may hear

Pneumoperitoneum: The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
Pelvic organ prolapse: Sagging of the bladder, uterus, top of the vagina, or rectum into or out of the vagina.
Vaginal vault: The top of the vagina, especially after a hysterectomy.
Cystocele: The bladder sagging into the front wall of the vagina.
Rectocele: The rectum bulging into the back wall of the vagina.
Sacral promontory: The upper front edge of the sacrum, where the mesh is anchored.
Surgical mesh: A soft, woven medical material that supports tissue and lets it grow in.
Mesh exposure: Part of the mesh showing through the vaginal lining.
Supracervical hysterectomy: Removing the uterus while leaving the cervix in place.
Sacrohysteropexy: Lifting the uterus with mesh to the sacrum instead of removing it.
Pessary: A removable silicone device placed in the vagina to support prolapse.
Native-tissue repair: A prolapse repair that uses your own ligaments and tissue, without mesh.
Colpocleisis: Surgery that narrows and closes the vagina to treat prolapse.
Urogynecologist: A specialist in female pelvic floor disorders, including prolapse and leakage.
Occult stress incontinence: Leaking with coughing that is hidden by prolapse and appears once the bulge is lifted.
Voiding trial: A check after surgery that you can empty your bladder well.

Common questions

Is this the mesh I have seen in lawsuits?

Most of the lawsuits and the 2019 FDA action involved mesh placed through the vagina for prolapse. Sacrocolpopexy places mesh through the belly. It has its own risks, including mesh exposure, which your surgeon should explain, but it has been studied for many years.

Is prolapse dangerous?

Usually not. It is treated because of the symptoms it causes. Rarely, severe prolapse blocks urine flow, which needs attention.

Will it fix my leaking?

Lifting the vagina can improve trouble emptying. Leaking with coughing is a separate problem and may need a sling. Urge leaking is treated with other methods.

Can I keep my uterus?

Often, yes. A sacrohysteropexy lifts the uterus without removing it. Your surgeon will discuss whether it suits you.

How long does the repair last?

It is one of the most durable prolapse repairs. Most women stay well supported for many years, though some prolapse can return over time.

Can the mesh be removed if there is a problem?

Small exposures are usually treated with estrogen cream or by trimming the exposed piece. Removing all of the mesh is a bigger operation and is rarely needed.

Will sex feel different?

Many women find sex more comfortable once the bulge is gone. Some have new discomfort, which often improves with time, lubricant, or vaginal estrogen.

Sources this page draws on

American College of Obstetricians and Gynecologists / American Urogynecologic Society, Pelvic Organ Prolapse (Practice Bulletin No. 214) (2019)
U.S. Food and Drug Administration, Urogynecologic Surgical Mesh Implants
New England Journal of Medicine (Brubaker and colleagues), Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence (CARE trial) (2006)
JAMA (Nygaard and colleagues), Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse (2013)
Urology Care Foundation, Pelvic Organ Prolapse

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.

Sacrocolpopexy (robotic mesh prolapse repair)

Overview

The parts of your body involved

Why it’s done

Other options

Getting ready

Weeks before

The week before

The day before

The morning of surgery

In the operating room, step by step

1. Anesthesia and positioning

After the operation

Right afterward

At home

Recovery timeline

What it feels like

Deciding about mesh

Waking up

The voiding trial

The first bowel movement

The first week at home

Noticing the bulge is gone

Getting back to sex