Single-port robotic-assisted laparoscopic sacrocolpopexy with magnetic retraction: first experience using the SP da Vinc
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ORIGINAL ARTICLE
Single‑port robotic‑assisted laparoscopic sacrocolpopexy with magnetic retraction: first experience using the SP da Vinci platform Vishnu Ganesan1 · Ramy Goueli1 · Dayron Rodriguez1 · Deborah Hess1 · Maude Carmel1 Received: 29 October 2019 / Accepted: 30 January 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The purpose of this study was to describe technical considerations and first outcomes from a single-port robotic-assisted sacrocolpopexy (RSC) using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA) and the Levita™ Magnetic Surgical System (San Mateo, CA, USA), a novel magnetic retraction system. Three females with pelvic organ prolapse elected to undergo RSC using the da Vinci SP platform. The supraumbilical incision length was 25 mm through which SP trocar was placed. A 12-mm assistant port was placed in the right upper quadrant. The external magnet was attached to the left side of the bed and used for bowel and bladder retraction. We then proceeded by duplicating the steps of our approach for a RSC performed using a multi-port robotic platform with necessary modifications given the SP approach. Intra-operative outcomes and peri-operative outcomes were collected and reported. The patients were women of 64, 66 and 73 years of age with BMI of 22, 25, and 34, respectively, and POP-Q stage III and IV prolapse. The RSC was performed between 198 and 247 min, estimated blood loss was 10–50 cc, and there were no complications. All patients were discharged home on post-operative day 1. All patients were doing well 1 month out with resolution of bulge symptoms. To our knowledge, this represents the first case series of robotic, magnetic-assisted sacrocolpopexies using the da Vinci SP platform and the Levita™ Magnetic Surgical System. It appears to be a safe and feasible approach, but long-term comparative studies will be necessary to assess functional outcomes. Keywords Single port · Sacrocolpopexy · Robotic assisted
Introduction Abdominal sacrocolpopexy is believed to be the most durable procedure for repair of apical prolapse or multi-compartment prolapse with apical component [1, 2]. However, the superior results of the abdominal approach compared to the vaginal approach have come at the cost of increased short-term morbidity [1]. The use of laparoscopy and robotics have improved blood loss and length of stay allowing for the benefits in durability of the abdominal repair while minimizing the short-term morbidity associated with the open procedure [3].
* Maude Carmel [email protected] 1
Department of Urology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390‑9110, USA
Evolution from multi-port robotic surgery to single-port robotic surgery has been increasingly used for prostatectomy [4, 5], since the development of specifically designed da Vinci SP robotic system from Intuitive Surgical. For sacrocolpopexy, there has been a report of a case series of 25 patients using a robotic platform adapted for single site, b
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