Gynecologic use of robotically assisted laparoscopy: Sacrocolpopexy for the treatment of high-grade vaginal vault prolapse

Daniel S Elliott, Igor Frank, David S Dimarco, George K Chow
American Journal of Surgery 2004, 188 (4): 52S-56S
Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade vaginal vault prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with vaginal repairs. In this article, we describe a novel minimally invasive technique of vaginal vault prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic vaginal vault prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1-12) months and mean age was 66 (range, 47-82) years. The mean total operative time was 3.2 (range, 2.25-4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for vaginal vault prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"