Combined Robotic Ventral Rectopexy and Sacrocolpopexy- a Single Institution Approach

Abstract

<h3>Study Objective</h3> To describe the multidisciplinary workup of pelvic organ prolapse and rectal prolapse or intussusception and to describe our technique of robotic ventral rectopexy and sacrocolpopexy. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> This is a patient with multi-compartment pelvic organ prolapse and rectal intussusception. <h3>Interventions</h3> The surgery is begun with the sacral dissection. The peritoneum is then opened in continuation along the right side of the rectum. Once the peritoneal reflection has been opened, it is carried down and further dissected from the posterior vagina. The deep pelvic dissection is then performed in the rectovaginal septum to the levator ani muscles, about five to six centimeters deep. Once the levator muscles are exposed, a ruler is introduced into the pelvis and the rectal width is measured. The anterior bladder dissection is then performed. A single sheet of flat, large pore, polypropylene mesh is then introduced and first secured to the levators bilaterally. Next the mesh is secured to the anterior rectum, sewing distal to proximal. This single sheet of mesh is then also used for the entire sacrocolpopexy by next securing the mesh to the posterior vagina. The mesh is then folded over the vaginal apex to the anterior vagina and before it is secured, the sacral tail is created by using the midportion of the mesh pulled out over the apex. The remaining steps of the procedure are completed in the same fashion as a standard sacrocolpopexy. <h3>Measurements and Main Results</h3> The patient had excellent anterior, apical, and posterior support with the use of a single flat sheet of lightweight mesh. The surgery had no complications with a minimal EBL. <h3>Conclusion</h3> Multidisciplinary treatment of concomitant pelvic organ and rectal prolapse by urogynecology and colorectal surgery allows for a safe and effective treatment of both conditions concurrently via a robotic ventral rectopexy and sacrocolpopexy with a single lightweight flat mesh sheet.