Robot-assisted sacrocolpopexy is performed in order to correct prolapse and/or herniation of the vagina, uterus, and bladder (cystocele). In this procedure, which is done in conjunction with a robotic hysterectomy, mesh is used to anchor the cervix to the sacral bone (a large triangular bone located in the upper back of the pelvis), thereby lifting the vagina and bladder into their normal anatomic positions. Robotic sacrocolpopexy can also be performed in women who have suffered a prolapse of the vagina (and sometimes the intestines as well—a condition known as enterocele) following a prior hysterectomy.
Traditional open abdominal sacrocolpopexy has been shown to be a durable and successful method of repairing symptomatic prolapse while maintaining natural vaginal depth and length. We have now adapted the techniques utilized in open surgery to robotic sacrocolpopexy. Robotic surgery offers a minimally invasive approach with several technical advantages for the surgeon, including enhanced visualization with magnification, reduced blood loss, improved suturing techniques compared to laparoscopy, and reproducible surgical results. And because robotic sacrocolpopexy avoids the need for a large abdominal incision, women undergoing this procedure are able to experience a less painful recovery with a significantly quicker return to normal activities than would be possible with open surgery.
In this procedure, the patient is placed under general anesthesia and five small incisions are made in the lower abdomen, allowing introduction of a camera, three robotic instrument arms and one accessory port for passage of sutures and mesh materials. In cases of advanced uterine prolapse, a hysterectomy will then be performed with preservation of the cervix. Following this, a small piece of polypropylene mesh is used to anchor the cervix, vagina and bladder to the sacral bone. In some cases, the uterus can be preserved and suspended in a similar manner—a procedure known as sacrohysteropexy. Finally, tissues are sewn over the mesh to form a barrier between the mesh and surrounding pelvic organs.
Reduced recovery time and hospital time. Since this procedure avoids the need for the large abdominal incision used in open surgery, most patients are able to resume normal activities within 3 to 4 weeks, compared to 6 to 8 weeks for an open sacrocolpopexy.
Less post-operative pain and less need for pain medications.
The superior precision and visualization of operative dissection offered by the da Vinci Si enhances the surgeon's ability to perform sacrocolpopexy with reduced blood loss and more accurate placement of suspension sutures.
The patient is able to maintain natural vaginal length and depth, resulting in reduced vaginal scarring and maintenance of female sexual function.
This procedure has been performed successfully at NYU Langone Medical Center since 2004 in women desiring durable prolapse repair with a minimally invasive approach. Dr. Nirit Rosenblum is one of the few experienced surgeons in the tri-state area to offer robotic surgery for the treatment of pelvic organ prolapse in women, including the option of uterine-sparing surgery (which avoids the need for a hysterectomy). This option of uterine preservation has been especially appealing to many patients, since women are often offered only repairs that include hysterectomy at other surgical centers.