Abstract Laparoscopic sacrocolpopexy (SCP) is the gold standard for apical prolapse, but presacral dissection may be unsafe or infeasible due to anatomical or surgical barriers. In such cases, alternative fixation methods are needed. We report three elderly women with advanced apical prolapse in whom robotic SCP was converted intraoperatively: one due to redundant sigmoid and bulky presacral vessels, one due to a fibrotic promontory with adherent vessels from prior spinal surgery, and one due to bowel redundancy and adhesions. All underwent unilateral pectineal suspension (UPS) with a lightweight mesh anchored to the right iliopectineal ligament when promontofixation was not feasible. UPS provided stable apical support and functional improvement in all cases. At follow-up, one showed mild asymptomatic mid-compartment descent, one had improved bladder emptying with persistent OAB, and one had excellent correction with mild residual stress incontinence. UPS with mesh is a safe, effective intraoperative alternative when SCP is not feasible.
Nobrega et al. (2025) studied this question.