Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Repair of Challenging Pelvic Prolapse

Patients undergoing laparoscopic or robotically assisted laparoscopic (minimally invasive) surgery for sacro(cervico)colpopexy recover faster, enjoy superior cosmetic outcome, have less pain and less blood loss as compared to laparotomy (traditional, open) surgery.

Robotically assisted laparoscopic sacro(cervico)colpopexy (RALSC) stands for suspension of the cervix/vagina towards the sacrum using mesh. RALSC is an outpatient surgery (no need for overnight hospital stay).

What is Pelvic Prolapse?

Pelvic prolapse includes protrusion/sagging of the cervix, vagina, bladder (cystocele), uterus (metrocele), bowel (enterocele), rectum (rectocele) or any combination of these. When all of these organs protrude beyond the vaginal opening it’s called procidentia.

Choosing a Minimally Invasive Gynecologic Surgeon

Performing RALSC requires a highly skilled minimally invasive gynecologic surgeon. The larger the prolapse, the more challenging is the RALSC. A very experienced surgeon can safely resolve severe pelvic prolapse still using minimally invasive techniques such as RALSC. Retrovaginal (not transvaginal) mesh placement is used.

If a surgeon is not experienced enough, then complications, such as injury to the bowel, rectum bladder, ureters or big blood vessels may occur at a higher rate. Alternatively, a less experienced surgeon may decide to convert to laparotomy in the middle of the operation.

Patients in a need for RALSC and are afflicted with severe pelvic prolapse should choose an experienced surgeon.

The key questions to ask are:

  • How complex of a prolapse has he/she resolved?
  • How many of these cases has he/she performed?
  • What is his/her complication rate?
  • What is his/her conversion rate?


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