PD32-03 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION. SURGICAL TECHNIQUE WITH 10 YEAR EXPERIENCE

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (PD32)1 Sep 2021PD32-03 ROBOTIC SACROCOLPOPEXY WITH UTERUS PRESERVATION FOR WOMEN WITH COMPLETE VAGINAL VAULT EVERSION. SURGICAL TECHNIQUE WITH 10 YEAR EXPERIENCE Cassandra Schuster, and Robert Carey Cassandra SchusterCassandra Schuster More articles by this author , and Robert CareyRobert Carey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002033.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic sacrocolpopexy with uterus preservation (RASCP-UP) is a transabdominal approach to repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and preserves female sexual organs. Although hysterectomy may be performed at the time of POP repair, many women choose to preserve their uterus for reasons of sexuality, female identity, religion, maintenance of maximal vaginal length, and resistance to removal of a normal organ. METHODS: Data is collected from an IRB approved prospectively maintained database of robotic POP repair in an 836 bed tertiary care hospital. The surgery is performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port. Commercially available 4 x 24 cm Y-shaped wide pore polypropylene mesh is modified to accommodate >10 cm anterior and posterior dissections of the vaginal walls. The anterior vaginal wall component is brought through the broad ligament and joined with the posteriorly placed component for attachment to the Anterior Longitudinal Ligament with GoreTex sutures. The mesh is then completely covered by peritoneum. All patients for RASCP-UP had Stage 4 prolapse with maximal anterior, posterior and apical descent with the cervix at the apex of the descent. All patients had normal PAP smears and pelvic ultrasounds. RESULTS: Between 2010 and 2021 a total of 351 patients underwent RASCP at the same institution. Of these, 54 presented with complete vaginal vault eversion requesting RASCP-UP. Mean age was 67.5 years and mean BMI 26.8. Cases were completed with robotic console time between 61 and 121 minutes and all patients discharged within 24-48 hours. At mean 60 month (12–124 month) follow-up, there were no mesh erosions, hernias, or reoperations for prolapse. There was one reoperation for hysterectomy at 6 year follow up for suspected endometrial carcinoma and one reoperation for small bowel obstruction in a patient with extensive lysis of adhesions. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence CONCLUSIONS: RASCP-UP is a reproducible, reliable procedure for patients with severe POP who desire uterus preservation. The surgery restores normal vaginal axis and length without placement of mesh material through vaginal mucosa. Long-term results show durable functional repair. Is the “unnecessary” removal of an otherwise normal uterus “necessary” for repair of POP? For a number of female patients, the answer appears to be no. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e545-e545 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassandra Schuster More articles by this author Robert Carey More articles by this author Expand All Advertisement Loading ...