Robotic Assisted Sacrocolpopexy

Robotic Assisted Transabdominal Sacrocolpopexy

This is a minimally invasive approach to treating prolapse of the vagina. The prolapse itself is variable with each patient as are the considerations of the approach used. Below is a brief outline of vaginal prolapse and associated issues as well as how this procedure can help. Prolapse is essentially a hernia of the vagina resulting from weakness of any combination of the ligaments and muscles supporting the vagina that gives the vagina its shape. When the weakness affects the floor of the vagina, a prolapse of the rectum occurs (rectocele). If the uterus is in place, this is another organ that can prolapsed from the back of the vagina. If the uterus has been removed, this type of prolapsed is called an enterocele and includes the intestines. The top of the vagina supports the bladder and urethra. When there is weakness under the bladder, a cystocele occurs which is bulging of the bladder into the vagina. All of these areas are strengthened by a sacrocolpopexy procedure.

Of note, weakness under the urethra can cause stress incontinence and this needs to be evaluated and possibly addressed separately but at the same time as the prolapse. The gold standard for repair of prolapse is called sacrocolpopexy. This is done through the abdomen and is done using synthetic mesh that is attached to the internal side of the vagina and possibly cervix (if a hysterectomy is done at the same time) on one side and then to the sacrum on the other side. The sacrum is the most posterior part of the pelvis. Although the type of mesh is similar to the type used through the vagina, the complication rates are lower and the strength of the repair is stronger.

It is important to understand that the current “vaginal mesh” controversies are in reality a controversy over surgical technique and not about the mesh itself despite what you see in inflammatory lawsuit driven commercials. We invite all of our patients to visit the FDA website for more detailed information.

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