Introduction 17 sacrocolpopexy are introduced, studies become necessary to understand how they affect surgical learning rates at the level of each phase. This can be done quicker and more objectively by using Artificial Intelligence (AI) techniques. Indeed, going through large volumes of lengthy surgical videos to annotate the duration of each phase, is time-consuming, and subjective and requires clinically trained staff. Automating this task, by surgical workflow segmentation, would thereby greatly assist in the investigation of surgical skills and the impact of procedural changes in sacrocolpopexy. Fig. 6. Sacrocolpopexy. Drawing by Myrthe Boymans. Any pelvic floor surgery may cause adverse events, including pain, dyspareunia, infection, voiding dysfunction, and other functional bladder and bowel symptoms. There are also adverse events uniquely associated with mesh use, such as mesh exposure and extrusion. The increasing number of reports of adverse events following the vaginal insertion of implants has led to the withdrawal or restricted use of vaginal prolapse mesh and, in some countries, of MUS as well. This has caused women and practitioners to become hesitant about pelvic floor surgery. Although we have argued for their effectiveness and limited invasiveness, their use is increasingly being questioned. Moreover, a study on patient preferences has shown that participants are willing to accept a slightly lower probability of cure to avoid substantial postoperative pain and possible complications by receiving a less invasive treatment..36 The rising reluctance to have mesh inserted over the past decade underscores the need for continuous monitoring of our surgical practices. Surgical modifications in sacrocolpopexy, including the use of new meshes that may be more biocompatible, might lower long-term mesh-related morbidity. At the same time, the potential benefits of “mesh-less” or mesh-free surgical alternatives, such as cervicosacropexy or vaginosacropexy (CESA/VASA), should be explored. These procedures involve the replacement of the USL with synthetic tapes and could cure both urinary incontinence and prolapse simultaneously.37,38
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