da Vinci Robotic Sacrocolpopexy
Robotic-assisted laparoscopic sacrocolpopexy is a surgical procedure for pelvic organ prolapse, a condition that occurs when one or more of the pelvic organs shift out of place, causing them to drop toward the vaginal opening. Female pelvic organ prolapse, or POP, is typically caused by the weakening of the muscles and tissues that support these organs.
This can be an uncomfortable and often embarrassing condition that prevents patients from participating in activities they enjoy. Prolapse symptoms often include feelings of tissue bulging in the vagina, pressure or pain in the pelvic area, sexual dysfunction, or other symptoms of pelvic floor dysfunction including problems urinary incontinence and constipation. Many treatments exist to alleviate symptoms and repair POP.
Robotic assisted laparoscopic sacrocolpopexy is a laparoscopic surgery that suspends the upper vagina using robotic assistance. It is a minimally invasive method performed with the patient under general anesthesia. Surgery using the da Vinci surgical system allows the surgeon to sit next to the patient and operate using small, fully wristed robotic instruments. Every hand movement the surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments, ensuring maximum precision.
What is robotic assisted laparoscopic sacrocolpopexy?
The goal of robot assisted laparoscopic sacrocolpopexy is to treat pelvic organ prolapse (either vaginal vault prolapse or uterovaginal prolapse) through a minimally invasive approach, with fewer risks and a shorter recovery time. The surgery involves using a graft of tissue or synthetic mesh, which is sewn onto the vagina and then attached to another area in the lower part of the spinal column. This suspension eliminates the vaginal prolapse and improves the sometimes severe symptoms associated with it.
There are a number of benefits to robot assisted sacrocolpopexy for pelvic organ prolapse repair in comparison to other surgeries. First, many patients experience fewer complications than those who get more traditional open surgery (called abdominal sacrocolpopexy) with a single, larger, incision.
Robotic sacrocolpopexy is done through a few small incisions in the abdomen. Second, patients may stay in the hospital for a shorter amount of time recovering. Finally, because of the size of the incisions and precision of the tools, using da Vinci technology leads to less trauma to surrounding tissues and less scarring after surgery.
Frequently Asked Questions about da Vinci Robotic Sacrocolpopexy
What are the risks of robotic-assisted sacrocolpopexy?
As with any major surgery, there are risks involved with sacrocolpopexy. More serious risks include injury to tissues and organs, infection, bleeding, pain during intercourse, blood clots, mesh-related complications, and recurrence of prolapse. For these reasons it’s imperative that patients discuss with their health care team if da Vinci surgery is right for them.
No matter the type of prolapse repair, patients are at risk for developing leakage of urine with laugh, cough, sneeze and other activities. Because of this, your surgeon will discuss ways to prevent stress urinary incontinence at the time of your reconstructive surgery.
Is sacrocolpopexy the only surgical option for pelvic organ prolapse?
Several surgical and non-surgical treatments for POP exist. Non-surgical interventions include certain lifestyle chances, pelvic floor exercises, and removable vaginal devices called pessaries. When these are not sufficient to treat the prolapse, surgical correction may be necessary. Surgical options include vaginal surgery, laparoscopic surgery, and robotic surgery. All of these surgeries can be performed with or without mesh or grafts.
Are there treatments for vaginal vault prolapse that do not use surgical mesh?
There are a number of non-mesh alternative treatments that exist. These can be performed vaginally laparoscopically, with or without robotic assistance. The decision to use mesh varies from one individual to the next and should play a role in the type of surgical management you choose to undergo. Let your doctor know if you have concerns about surgical mesh or grafts.
Is robotic sacrocolpopexy a minimally invasive surgery?
Yes, the surgery is considered minimally invasive because of the advanced technology available to perform it. During the procedure, the surgeon places small tools and a tiny camera into small incisions in the lower belly, rather than a larger single incision. The robotic assistance allows for small and precise movements, ensuring a more successful outcome, including less tissue damage or trauma.
The da Vinci robotic system by intuitive surgical is the industry standard for robotic assisted surgery and is used not only in gynecologic surgery, but also in nearly every other surgical specialty.
When is robotic sacrocolpopexy necessary?
Robotic sacrocolpopexy is necessary to repair pelvic organ prolapse when other alternative methods have failed or when patients prefer the most durable repair. Sacrocolpopexy is generally considered the “gold standard” of prolapse surgery and, because of the use of a graft material, has the lowest risk of recurrent prolapse.
Robotic assisted sacrocolpopexy should be considered after a thorough discussion of its risks, benefits, and alternatives. Only a doctor and patient can make the decision together based on the specific factors of their condition and the patient’s goals for short and long term recovery.
How long does it take to recover from a sacrocolpopexy?
Usually, the recovery time for a traditional open abdominal sacrocolpopexy can be as long as 6 to 8 weeks. With a robotic assisted sacrocolpopexy, the patient usually stays in the hospital for only one night, in order to evaluate the surgery and assist in pain management. In general, patients only require minimal pain medicine. Once discharged from the hospital most patients feel considerably better within a few weeks. Further recovery at home involves avoiding heavy lifting or strenuous exercise for at least 6 weeks, and sexual intercourse for 6-8 weeks. All in all, the less invasive procedure means less pain, less risk of complications, and a shorter overall recovery before returning to normal activities.
Is sacrocolpopexy major surgery?
As it involves being put under general anesthesia and surgery of major organs, sacrocolpopexy is a major surgery. However, less invasive laparoscopic procedures do have fewer risks of complications and a shorter recovery time compared to open surgeries such as abdominal sacrocolpopexy.
I have concerns about synthetic mesh. What does the FDA say about it?
The risks and benefits of using surgical mesh depend on the procedure. In 2019, the FDA ordered mesh manufacturers to stop selling devices for transvaginal repair of pelvic organ prolapse, asserting that the benefits do not outweigh the risks of surgical mesh placed transvaginally to treat POP. However, the positioning and anchoring of the mesh used in robotic laparoscopic sacrocolpopexy has been deemed safe by the FDA and it is not associated with significant complications. One of the advantages of sacrocolpopexy include a reduced risk of mesh exposure, compared to insertion of vaginal mesh.