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Overview – What is robotic-assisted sacrocolpopexy?

Sacralcolpopexy is widely regarded as the gold standard surgical procedure for treating pelvic organ prolapse (POP). It can be performed either via laparotomy as well as laparoscopically – with or without the aid of the da Vinci robot. Robotic technology in Sacralcolpopexy makes the use of special tools and provides assistance to the surgeons by facilitating a host of benefits including better visualization, lesser blood loss, smaller incisions, and overall greater levels of effectiveness & efficiency. Moreover, patients can expect shorter hospital stay and lower risk of complications, than would be possible with open surgery, with this advanced minimally invasive method. Without a doubt, robotic-assisted Sacralcolpopexy has been proven to be an easier and quicker surgical method for the practising surgeon.

Why one might need robotic-assisted sacrocolpopexy?

The pelvis can be better described as a bowl-shaped cavity which is made up of several bones located in the lower part of the abdomen. These are houses various organs including the uterus, the bladder, along with the lower part of the intestines. Further, these organs are held in place with the help of strong tissues. If at all, a situation was to arise where the tissues residing in these parts were to weaken, it may result in one or several organs dropping down which may cause it to apply additional pressure or bulging into the vagina.
This fault can be described as a pelvic organ prolapse.

Robotic-assisted sacrocolpopexy has been proven as an effective solution to fix this problem. With the aid of this method, surgeons are able to pull up the tissues allowing the organs to move back into place. Vaginal vault prolapse is a type of pelvic organ prolapse which is treated with this method. Usually, after a hysterectomy procedure, the upper part of the vagina lowers down into the lower part or in some cases, may also be pushed outside the vaginal opening. By making use of a synthetic mesh or biological graft – obtained from a ligament on front of the sacrum (tail bone) – the vagina is then suspended internally after it has been attached to the top and bottom sides of the vagina. In some cases, the sewing might be done on the uterus for the purpose of a hysteropexy/uterine preservation (which avoids the need for a hysterectomy). Some women also choose to have other procedures in conjunction with this surgery such as getting their uterus removed (hysterectomy) or surgery for urinary incontinence.

Additionally, robotic-assisted sacrocolpopexy can be used to help relieve certain types of symptoms of pelvic organ prolapse, including:

  • A feeling of fullness or increased pressure in the vagina
  • A sudden urge to urinateSevere pain experienced with sexual intercourse
  • Presence of a bulge in the vaginal region or tissue bulging out from the vagina
  • Urinary incontinence
  • Constipation

 

What happens during a robotic-assisted sacrocolpopexy?

Before the procedure, general anaesthesia will be administered to prevent the occurrence of pain. In the same vein, the patient might be antibiotics before and after the surgery in order to help prevent infection.

This procedure avoids the need for a large abdominal incision which is required in case of a traditional open abdominal sacrocolpopexy. During the procedure, small incisions (less than 1 cm incisions typically) will be made on the lower part of the abdomen through which small tools along with a tiny camera called a laparoscope will be inserted.

This enables the surgeon to have a clearer view and more space while working. CO2 gas will also be inserted to aid visibility. With the aid of a robotic controller, the surgeon will move the tools which allow the surgeon to perform tiny and precise movements.

In case a hysterectomy needs to be performed, then the surgeon will proceed to remove the uterus initially. At times, the cervix might remain untouched if both the patient and the surgeon decide it's the best course of action. Any potential complications can also be avoided that way.

Next, the prolapsed part of the vagina will be lifted by the surgeon using the tools and a graft of tissue or synthetic mesh will be sewn onto the pelvic organs that have prolapsed. This graft is then attached to a strong tissue present in the pelvic area – usually a bony area at the lower part or base of the spinal column – with the help of stitches or tacking devices. This procedure helps in keeping the pelvic organs in place.

Any additional procedures which might be required to repair a prolapsed rectum, bladder, or other tissues may be performed at this juncture. Any overlying tissue might also be sewed over to decreased the chances of bowel obstruction.

Finally, the tools will be taken out following which the surgeon will proceed to close and bandage the incisions.

In addition to the array of advantages, getting a robotic-assisted sacrocolpopexy also allows the patient to maintain natural vaginal length and depth which, in turn, leads to reduced vaginal scarring along with maintenance of female sexual function.

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Dr. Mohan Keshavamurthy

Director Urology, Uro-oncology, Andrology, Transplant & Robotic Surgery

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Dr. Shakir Tabrez

Senior Consultant - Urology, Uro-oncology, Andrology, Transplant & Robotic Surgery

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Dr. Prem Kumar

Consultant Urology & Andrology

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Dr Santosh Kumar Subudhi

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Dr. Basavaraj Neelgar

Consultant Urology, Uro-oncology, Andrology - Transplant & Robotic Surgery

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Dr. Karthik Rao

Consultant Urology & Kidney Care

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