Tips for Performing a Combined Robotic Assisted Sacrocolpopexy and Ventral Rectopexy

Abstract

Study Objective In this video we highlight our technical tips for performing a combined robotic sacrocolpopexy and ventral rectopexy for concomitant posterior, middle and anterior compartment prolapse. Design Video submission. Setting Collaboration between FPMRS and Colorectal Surgery specialists in a community teaching hospital. Patients or Participants 55 year-old G1P1 overweight female s/p laparoscopic hysterectomy and bilateral oophorectomy for endometriosis presenting with severe obstructed defecation syndrome (ODS) and incomplete bladder emptying. On exam she had a grade 2 rectocele, a grade 1 vault prolapse, and a grade 2 cystocele. She scored 22 points on a KESS constipation questionnaire. A 3D transvaginal/transrectal and translabial ultrasound showed a grade 3 rectocele, enterocele causing rectal intussusception and a cystocele that descended below the pubic bone. Interventions For the robotic surgery the patient was positioned in dorsal lithotomy and maximum Trendelenburg. She underwent a combined robotic assisted laparoscopic sacrocolpopexy with polypropylene mesh and ventral rectopexy with cross linked porcine dermis mesh. Measurements and Main Results Preoperative and 3 months postoperative 3D transvaginal/ transrectal and translabial ultrasounds, KESS constipation questionnaire, PFDI-20, and PFIQ-7. Three months after her surgery her ODS symptoms have resolved, her KESS score dropped from 22 to 12 points, and on repeat ultrasound she had no residual pelvic prolapse, no obstruction on straining and no cystocele. Conclusion For patients with vaginal vault prolapse, cystocele, and rectocele a combined sacrocolpopexy and ventral rectopexy can be an effective surgical intervention.