Robot-Assisted Abdominal Sacrocolpopexy

The bladder, reproductive organs, and other structures in the bowl-shaped pelvic area need to be positioned properly in order to properly function.

Normally, strong tissues keep everything in place to allow this to happen. However, if certain tissues weaken, organs may slip out of their original position and slide downward. Sometimes, it's the vaginal vault that's primarily affected. If this happens, it's a type of pelvic organ prolapse (POP) referred to as a vaginal vault prolapse.

An option for correcting this problem is a robot-assisted abdominal sacrocolpopexy.

Why Might a Robotic-Assisted Sacrocolpopexy Be Recommended?

Women with POP don't always need surgery. In fact, steps may be taken to correct vaginal vault prolapse with non-surgical methods if future plans include attempts at becoming pregnant. It's when options that may include the use of a pessary that's inserted into the vagina or pelvic floor exercises aren't effective that surgery may be discussed. A robot-assisted abdominal sacrocolpopexy may benefit patients experiencing:

• Issues from a vagina that has folded down into the lower portion
• Severe prolapse that occurred after a hysterectomy
• Persistent feelings of fullness in the vagina
• Urinary incontinence due to the prolapse
• Pain associated with intercourse
• Chronic constipation and similar issues affecting quality of life

What Happens Before Surgery?

Before a robot-assisted abdominal sacrocolpopexy is performed, a urologist typically performs several tests to get a better idea of how the prolapse is affecting urinary and reproductive system functions. Such testing often includes blood and urine tests, image tests, and an evaluation of a patient's overall health. Patients are sometimes given antibiotics to reduce the risk of infection.

How Is the Procedure Done?

Performed under general anesthesia, a sacrocolpopexy is done with incisions made into the abdomen to pull tissues up to lift the vagina back into the correct position. Synthetic mesh or graft material is used to secure the repositioned tissues in place to prevent a prolapse from recurring. Additional steps may be necessary if the bladder and other organs are also misaligned.

How Is Robotic-Assisted Sacrocolpopexy Different from Standard Surgery?

A robot-assisted abdominal sacrocolpopexy is a minimally invasive approach to surgery that's performed with the urology surgeon sitting in a remote unit in the same room as the patient. During the procedure, the surgeon will have a detailed view of the affected part of the pelvic area on a monitor capable of producing very detailed images. The surgeon's hand movements are transferred from the controller to the robotic arm, which is also used to insert specially designed surgical and manipulate instruments. Patients often benefit from:

• Fewer complication risks
• Less risk of damage to nerves and soft tissues
• Shorter recovery times
• Increased accessibility since the robotic arm can make movements not possible by human hands

Success rates for sacrocolpopexies are fairly high; up to 90 percent, according to some estimates. When robot-assisted guidance is part of the procedure, the increased precision may reduce risks even further for patients who would likely benefit from this treatment for POP involving the vaginal vault. Depending on the extent of the prolapse and what structures are affected, a urologist may also recommend removal of the uterus (colpocleiesis), closure of all or part of the vagina with obliterative surgery, or a sacrohysteropexy, a similar procedure to correct uterine prolapse.