Robotic-assisted laparoscopic sacrocolpopexy for stage III pelvic organ prolapse

Christine Louis-Sylvestre, Martine Herry
International Urogynecology Journal 2013, 24 (5): 731-3

INTRODUCTION AND HYPOTHESIS: Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse and can be performed laparoscopically. Robotic assistance allows optimal dissection and placement of the prosthesis. We present a video of our technique along with the results on 90 patients.

METHODS: We perform a posterior dissection down to the levator muscles and an anterior dissection down to the trigone. The meshes are made of polyester (mersuture®). The posterior mesh is sutured to the levator muscles, to the rectum above the anorectal junction, below the uterosacral ligaments, and to the isthmus/cervix. The anterior mesh is sutured to the vagina and the isthmus/cervix and attached to the promontory with a tension measured through a vaginal exam.

RESULTS: We operated on 90 patients. There was an additional procedure in 71 cases (either subtotal hysterectomy, adnexectomy, adhesiolysis, or rectopexy). The mean operative time was 246 min (180-415). Perioperative complications were one vaginal effraction and a case of sigmoidal perforation during an adhesiolysis. Early complications were two cases of bowel hernia through port sites. The mean hospital stay was 3.48 days (2-11). The mean follow-up is 15.6 months (range 1-45). Six patients have a persistent stage II prolapse. We observed no retraction of the prosthesis and no dyspareunia.

CONCLUSIONS: With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point.

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