Robotic-Assisted Laparoscopic Sacrocolpopexy

Specialist:
Yi-Jen Chen
Ling-Yu Jiang

Overview

Pelvic organ prolapse is a common issue affecting up to 50% of parous women. It is a condition in which the bladder, uterus, vagina, and/or rectum descend from their normal positions in the pelvis and sometimes protrude through the vaginal opening. This can cause symptoms such as protrusion, complications with voiding, defecating, and sexual dysfunction and negatively impact a person's quality of life.

Features

Sarcrocolpopexy is an important procedure for repairing enterocele and vaginal vault prolapse and can also be used to provide apical support during concurrent hysterectomy. The procedure involves suspending the vaginal apex to the anterior longitudinal ligament on top of the sacral promontory. It can be performed through abdominal, laparoscopic, or robotic approaches.

Procedure

The peritoneum over the first sacral joint is opened during the procedure to expose the anterior longitudinal ligament and middle sacral vessels. The peritoneum over the vagina is also opened to access the rectovaginal and vesicovaginal spaces. Once these spaces are opened, and the bladder and rectum are mobilized, the appropriate length for the mesh arms is assessed. A Y-shaped mesh with a tail is then attached to the sacrum using two or three sutures, and a permanent suture is made through the full thickness of the anterior and posterior vaginal wall. The peritoneum is closed over the mesh to cover the bridge of mesh between the vaginal apex and sacrum, which helps to reduce the risk of adhesion and bowel obstruction.

Notification

Risks and Complications

• Bladder, ureter, and bowel injury

• Recurrence of prolapse

• Urinary tract infection

• Hemorrhage

• Ileus

• Dyspareunia

• Mesh exposure/erosion

• Urinary incontinence