Robotic sacro-colpopexy for treatment of pelvic organ prolapse

What is pelvic organ prolapse?

Pelvic organ prolapse is a downward descent of female pelvic organs, including the bladder, uterus and the small or large bowel. These organs can slipout of the normal position and create a bulge in the vagina. The bulging can worsen over times, and can extend outside the vaginal opening.

Four main types of pelvic organ prolapse can occur:

  1. Cystocele – the protrusion involves the front (anterior wall) of the vagina and bladder
  2. Rectocele – the back (posterior wall) of the vagina and rectum are involved
  3. Enterocele – the upper portion of the vaginal wall and small bowel are involved
  4. Uterine prolapse – the uterus descends downward

Prolapse often affects postmenopausal women who’ve had one or more vaginal deliveries. Damage sustained by supportive tissues during pregnancy and childbirth, plus the effects of gravity, loss of oestrogen and repeated straining over the years, can weaken pelvic floor muscles and tissues and lead to prolapse.

What are the treatment options for prolapse?

Treatment options depend on the circumstances of each patient and the severity of the prolapse. Possible options include:

Non-surgical options:

  • Pelvic floor exercises – strengthen the pelvic floor muscles
  • Pessaries – plastic or silicone devices inserted into the vagina to provide support to pelvic organs and structures

Surgical options:

  • Vaginal prolapse surgery
  • Vaginal closure / obliteration surgery (colpoclesis)
  • Sacro-colpopexy

What is roboticsacro-colpopexy?

Sacro-colpopexy refers to suspending and/or supporting the vagina via a ligament on the sacrum using mesh. It is indicated in patients with severe prolapse, in patients who have failed previous vaginal repairs or in younger patients. Sacro-colpopexy has excellent long-term results.

Sacro-colpopexy can be performed through an open incision, using traditional keyhole surgery, or using robotic assisted keyhole surgery. Robotic sacro-colpopexy is performed using Da Vinci robotic arms controlled by the surgeon. Four to five tiny incisions, similar to traditional keyhole surgery, are used to access pelvic organs with the robot arms. The da Vinci System features a magnified 3D HD vision system and tiny wristed instruments that bend and rotate far greater than the human hand. These features enable surgeons to operate with enhanced vision, precision, and control – even for complex cases.

What to expect after roboticsacro-colpopexy?

Compared to open surgery, there is a shorter hospital stay, less blood loss and quicker recovery from surgery.

After the surgery you will wake up with a urinary catheter tube placed in the bladder through the urethra. You should be able to eat and drink normally and get up and walking the next day. The catheter will be removed the morning after surgery.

You will likely be discharged day 2 after the operation depending on how comfortable you are.

You’ll need to resume your activity level gradually. You should not lift anything heavy for four weeks after the operation. You should be back to your normal routine in about four to six weeks.