Robotic-assisted laparoscopic sacrocolpopexy for stage III pelvic organ prolapse
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VIDEO ARTICLE
Robotic-assisted laparoscopic sacrocolpopexy for stage III pelvic organ prolapse Christine Louis-Sylvestre & Martine Herry
Received: 27 October 2012 / Accepted: 24 November 2012 / Published online: 12 January 2013 # The International Urogynecological Association 2013
Abstract Introduction and hypothesis Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse and can be performed laparoscopically. Robotic assistance allows optimal dissection and placement of the prosthesis. We present a video of our technique along with the results on 90 patients. Methods We perform a posterior dissection down to the levator muscles and an anterior dissection down to the trigone. The meshes are made of polyester (mersuture®). The posterior mesh is sutured to the levator muscles, to the rectum above the anorectal junction, below the uterosacral ligaments, and to the isthmus/cervix. The anterior mesh is sutured to the vagina and the isthmus/cervix and attached to the promontory with a tension measured through a vaginal exam. Results We operated on 90 patients. There was an additional procedure in 71 cases (either subtotal hysterectomy, adnexectomy, adhesiolysis, or rectopexy). The mean operative time was 246 min (180–415). Perioperative complications were one vaginal effraction and a case of sigmoidal perforation during an adhesiolysis. Early complications were two cases of bowel hernia through port sites. The mean hospital stay was 3.48 days (2–11). The mean follow-up is 15.6 months (range 1–45). Six patients have a persistent stage II prolapse. We observed no retraction of the prosthesis and no dyspareunia. Conclusions With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point. Electronic supplementary material The online version of this article (doi:10.1007/s00192-012-2016-4) contains supplementary material, which is available to authorized users. C. Louis-Sylvestre : M. Herry (*) Department of Obstetrics and Gynecology, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France e-mail: [email protected]
Keywords Pelvic organ prolapse . Robotic sacrocolpopexy . Robotic sacrohysteropexy . Pelvic reconstructive surgery
Aim of the video Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse with fewer recurrences and a decreased risk of mesh exposure compared to the vaginal approach. The laparoscopic route allows a minimally invasive approach for this procedure but is not easily mastered. Our team is well trained in laparoscopic sacrocolpopexy, but introduction of robotic assistance was the next logical step as the robot provides enhanced vision and increased dexterity to the surgeon (7° of freedom of the tip of the instrument), thus allowing optimal dissection and placement of the prosthesis. We decided to assess the feasibility and the advantages of robotic-assisted sacrocolpopexy and offered patients a robotic-assisted procedure whenever the robot was av
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