The 26-Minute Laparoscopic Sacral Colpopexy: Do We Really Need Robotic Technology?

Abstract

To demonstrate the technical steps of a laparoscopic sacral colpopexy (LSC), demonstrate the efficiency of LSC, review the comparative LSC and robotic-assisted sacral colpopexy (RSC) literature, and challenge surgeons' conventional wisdom regarding RSC. Use of a time-stamped video with a step-by-step explanation of the technique and slides of comparative trials and benefits of robotic surgery. Sacral colpopexy remains the gold standard surgical procedure for treating vaginal vault prolapse. It can be performed via laparotomy, laparoscopically with or without robotic assistance. Robotic technology has been marketed based on unsubstantiated claims, including better visualization, smaller incisions, less blood loss, and greater efficiency. Conventional wisdom suggests that robotic-assisted laparoscopic surgery is easier and thus faster for the practicing surgeon. A time-stamped video of LSC in a woman with vaginal vault prolapse was performed in 26 minutes using 14 sutures in the vagina and 2 sutures in the presacral ligament. The stopwatch began after placement of the scope in the abdomen and before placement of the 3 accessory posts and ended with peritoneal closure over the sacral colpopexy mesh. The patient signed a consent and release form for the use of her video for educational purposes. A review of the literature suggests that the average RSC takes 260 minutes; the average is 200 minutes with the conventional LSC technique, realizing a time savings of at least 60 minutes. Our 26-minute LSC supports this finding.