# Critical Care and Surgical Management of Vascular Complications in Minimally Invasive Urological Reconstructive Surgery

## TL;DR

This paper reviews how to manage and prevent serious vascular complications during minimally invasive pelvic floor reconstructive surgeries.

## Contribution

The paper provides a comprehensive review of vascular complication management in sacrocolpopexy and artificial urinary sphincter procedures.

## Key findings

- Vascular complications are serious but preventable with proper surgical technique and planning.
- Dissection of the sacral promontory requires detailed knowledge of pelvic anatomy to avoid injuries.
- Preoperative planning can help identify alternatives for mesh fixation when standard anatomical locations are not viable.

## Abstract

Background: Despite the benefits of minimally invasive pelvic floor reconstructive surgery, serious life-threatening complications have been described. The most serious complications are vascular and intestinal. This review discusses the incidence, diagnosis, management and prevention of vascular complications in minimally invasive pelvic floor reconstructive surgery (sacrocolpopexy and artificial urinary sphincter). Objectives: We aimed to determine the incidence and management of vascular complications in minimally invasive pelvic floor reconstructive surgery. Methods: This narrative literature review on the incidence and management of vascular complications at sacrocolpopexy and artificial urinary sphincter was performed after the search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in English between January 2011 and June 2025. The keywords used were “vascular”, “complication”, “sacrocolpopexy”, and “artificial urinary sphincter”. We selected 19 manuscripts for comprehensive review. Conclusions: Dissection of the sacral promontory during sacrocolpopexy requires an exquisite knowledge of pelvic anatomy and adequate preoperative planning to avoid vascular injuries and find alternatives for mesh fixation if it cannot be performed in the usual anatomical location.