Surgical technique of robot-assisted laparoscopic sacrocolpopexy

Abstract

: Comparing to the laparoscopic approach, robotic surgery provides many advantages, facilitating the operating process, improving results and making it more comfortable for the surgeon. Sacrocolpopexy (SCP) is the most beneficial technique for apical prolapse, despite its complexity, so the robot’s assistance could make it more convenient. Steps of SCP are the following: (I) peritoneal opening with further mobilization of the longitudinal presacral ligament, mm. pubococcygeus, perineal body, posterior and anterior vaginal walls. Subtotal hysterectomy should be done if the uterus is present. (II) Fixation of the posterior part of the mesh to mm. levator ani, perineal body, the posterior vaginal wall, and vaginal cuff or cervix. Fixation anterior part of the mesh to the anterior vaginal wall and vaginal cuff or cervix. (III) Fixation of the mesh to the longitudinal presacral ligament in the area of promontorium. (IV) Peritoneal closure and vaginal packing. From January 2013 to December 2019, 181 patients underwent RA SCP in our department. Long-term assessment (more than 1 year) was made in 74 patients. There weren’t found graft-related complications requiring additional surgery. Seventy (94.6%) of patients claimed excellent and good subjective results showing improvement in scoring using pelvic organ prolapse questionnaires. Sixty-one (82.4%) showed good and excellent anatomical results showing an absence of prolapse or stage I prolapse recurrence. However, 13 (17.6%) patients showed recurrent II–III stage of cystocele. RA SCP is the operation of choice in sexually active women with apical prolapse. Robotic surgery has advantages comparing laparoscopic approach in obese patients, women with dense or strong intraabdominal adhesions, recurrent pelvic organ prolapse after laparoscopic or vaginal mesh repair.