ROBOT ASSISTED SACROCOLPOPEXY – TIPS AND TRICKS

Mehul Agarwal M1, Ankur Mittal A1, Kunal Malhotra K1, Vikas Kumar Panwar V1, Prof Arup Kumar Mandal A1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 861
Non Discussion Video
Scientific Non Discussion Video Session 200
Robotic-assisted genitourinary reconstruction Pelvic Organ Prolapse Bowel Evacuation Dysfunction
1. All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Links

Abstract

Introduction
Pelvic organ prolapse (POP) is a common problem among women. The surgical repair of POP continues to evolve from the traditional transvaginal suture repair to open mesh sacrocolpopexy to minimally invasive techniques of laparoscopy and Robotic sacrocolpopexy. Abdominal sacrocolpopexy (ASC) is considered to be the gold standard treatment for vaginal vault prolapse. Numerous studies have shown this procedure to have high success rates (78–100%) and long-term durability. The procedure is associated with significantly less recurrent prolapse when compared to vaginal reconstruction procedures. (1) Despite its rising adoption, Robot assisted sacrocolpopexy (RSCP) has not been fully standardized yet.(2)
Design
A 46 year lady presented with complaint of something coming out per vagina associated with voiding Lower urinary tract symptoms since 5 years. Patient had past history of Total abdominal hysterectomy 10 years back in view of abnormal uterine bleeding. Patient was subsequently diagnosed as Stage 4 Vault prolapse and planned for Robot assisted sacrocolpopexy.
Results
We aim to provide 10 commandments of RSCP with few tips and tricks which might improve postoperative outcomes in patients.  
We prefer using single mesh hand shaped in Y configuration by the surgeon. Synthetic polypropylene mesh has shown durable results with minimum risk of mesh erosion. (3)
Posterior and anterior dissection was done close to vagina and posterior limb of mesh is sutured distally to posterior vaginal wall to lift mesh closure to vagina and thus avoiding interference with rectum avoids postoperative bowel dysfunction. (2) 
Mesh is placed fixed over anterior and posterior vaginal wall while avoiding breaching the vaginal mucosa for a length of 4-6cm using 3-4 sutures only and stitches to vault is avoided to avoid breaching mucosa at apex.
Closure of peritoneum is done to avoid contact of bowel with prolene mesh however several studies have proposed no significant risk of adhesions and bowel obstruction, if mesh is not retroperitonealised. (3)
Postoperative period was uneventful with patient voiding normally post catheter removal. Post 1 month follow up patient is voiding normally without prolapse.
Conclusion
Robotic assisted sacrocolpopexy enables the successful correction of Vault prolapse with preservation of vaginal length and minimal complications.
References
  1. Hudson CO, Northington GM, Lyles RH, Karp DR. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2014 Sep-Oct;20(5):252-60.
  2. Li Marzi V, Morselli S, Di Maida F, Musco S, Gemma L, Bracco F, Tellini R, Vittori G, Mari A, Campi R, Carini M, Serni S, Minervini A. Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up. Ther Adv Urol. 2022 Apr 21; 14:17562872221090884.
  3. Gilleran JP, Johnson M, Hundley A. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010 Oct;2(5-06):195-208
Disclosures
Funding No funding or grant Clinical Trial No Subjects Human Ethics not Req'd Video presentation does not require ethical clearance according to institutional ethics committee Helsinki Yes Informed Consent Yes
14/11/2024 07:23:27