Robotically Assisted Laparoscopic Sacrocolpopexy
FM was a 56-year-old patient with a history of 4 vaginally delivered children. She expressed concern about progressively worsening vaginal pressure and bulge. A “ball like” formation would protrude between her thighs at the end of the day or after strenuous physical activity. This seriously impacted her quality of life including such activities as walking, sitting, exercising and vaginal intercourse.
FM’s OB/GYN determined that she had a prolapsed uterus and vagina. The initial solution was to use a ring shaped insertable device called a pessary. FM tried 4 different types and found all of them very uncomfortable. Seeking a definitive solution, she turned to Atlanta Minimally Invasive Gynecological Surgery Center where she was advised to undergo a Robotically Assisted Laparoscopic Supracervical Hysterectomy (RALSH) combined with a Robotically Assisted Laparoscopic Sacrocolpopexy (RALSCP).
Patient Results and Benefits of Minimally Invasive Robotically Assisted Laparoscopic Sacrocolpopexy
The RALSH and RALSCP were both performed successfully and FM was able to return home the same day. She was able to return to light duty activities in 2 weeks and all activities, including vaginal intercourse, within 6 weeks. Her vaginal pressure and bulge issues were completely resolved.
Proper recognition and understanding of surgical anatomy is paramount to successful and safe completion of any surgery, including RALSCP. Correct tissue handling and “prophylactic” hemostasis are equally important. These principles need to be followed regardless of the sacrocolpopexy route. Employment of Robotic and/or Laparoscopic instrumentation can’t “miraculously” replace or even enhance these principles.
Clear preoperative indication for RALSCP needs to be established. Patients who are and/or will not be sexually active will benefit from colpectomy/colpocliesis (no usage of mesh) instead. Middle sacral vessels and left common iliac vein are especially prone to be injured. Avoidance of over-tension of the sacrovaginal suspension is important. Complete retroperitonealization of the mesh is imperative to prevent small bowel adherence and obstruction.