Laparoscopic Repair of Pelvic Prolapse
When the natural mesh-like tissue and ligaments that hold pelvic structure in place begin to fail, the result is a condition known as Pelvic Organ Prolapse (POP). Pelvic organ prolapse occurs with descent (sagging/drooping) of one or more pelvic structures: the uterus/cervix (metrocele/uterovaginal prolapse), vaginal cuff (vaginal cuff prolapse), anterior vagina/bladder (cystocele), posterior vagina/rectum (rectocele), or peritoneum of the cul-de-sac/small intestine (enterocele). To explain this in more detail, a well supported vagina can withstand natural intra-abdominal/pelvic pressure. Such proper vaginal anatomical position and performance depends on adequately functioning endopelvic fascia. Fascia is an intricate natural elastic mesh layer lining the entire pelvic floor. Pelvic organs (bladder, uterine cervix, rectum and vagina) are partially embedded into the endopelvic fascia. Weakening or breaks of the fascia result in different types and degrees/stages of pelvic floor relaxation. The stages/grades of POP are determined on physical exam and depend on whether or not the prolapse is still inside the vagina or protruding outside the vagina. Possible risk factors for pelvic organ prolapse include genetic predisposition, number of full term pregnancies (particularly vaginal birth), menopause, advancing age, prior pelvic surgery, connective tissue disorders, and factors associated with elevated intra-abdominal pressure such as obesity and chronic constipation with excessive straining.
If conservative treatments are unsuccessful, contraindicated, or undesired, there are multiple available surgical procedures for patients who desire to preserve the vaginal canal and have the option of future vaginal intercourse. The surgical approach depends on the patient’s symptoms, type of prolapse, the patient’s history of previous abdominal/urogynecological surgeries, as well as the surgeon’s level of skill and comfort. Laparoscopic/Robotic Repair of Pelvic Prolapse (Laparoscopic Sacrocolpopexy or Robotic Assisted Laparoscopic Sacrocolpopexy) is the most effective, permanent, minimally-invasive surgical solution. It involves suspension of the vagina towards the sacrum using polypropylene mesh. This is an outpatient procedure with only three small incisions, requiring only about a 2 week recovery at home. Abdominal (non-laparoscopic) sacrocolpopexy has been the “gold standard” and the most effective surgical resolution of pelvic prolapse for more than 50 years. It requires a 5-10 inch abdominal incision, 2-3 day hospital stay and 6 week recovery at home. At AMIGS, we perform this procedure laparoscopically or robotically. The advantages of a laparoscopic procedure are many. Patients usually go home the same day, the recovery time is faster and less painful, and the cosmetic outcome is better. Sometimes this procedure is combined with other vaginal procedures such as anterior/cystocele, posterior/rectocele, and/or paravaginal repairs.