Robotic Sacral Colpopexy Research Articles

Sacral Osteomyelitis After Robotically Assisted Laparoscopic Sacral Colpopexy

Osteomyelitis associated with using synthetic mesh for laparoscopic sacral colpopexy is rare. We present a patient who developed Staphylococcus sacral osteomyelitis after sacral colpopexy with synthetic mesh and titanium tack fixation to the sacral promontory in the absence of mesh erosion or fistula formation. The patient presented with low back pain 6 weeks postoperatively. Magnetic resonance imaging, bone aspirate, and culture confirmed sacral osteomyelitis and discitis 10 weeks after surgery. The patient underwent 8 weeks of outpatient antibiotic treatment. Six months after surgery, serial laboratory values have demonstrated excellent response to antibiotic treatment, and the patient has clinically improved without the need for mesh removal. We recommend a high index of suspicion for osteomyelitis in patients who present with back pain after sacral colpopexy. Osteomyelitis can occur as a complication of laparoscopic, robotic sacral colpopexy using mesh in the absence of abscess or fistula formation.

Video 7

OBJECTIVE: The purpose of this video is to demonstrate advantages of performing hysterectomy at the time of robotic sacral colpopexy by the vaginal approach. DESCRIPTION: The video begins with a total vaginal hysterectomy performed on a woman with a stage 2 cystocele and a stage 2 uterovaginal prolapse. After the uterus and cervix are removed, the vesicovaginal and rectovaginal planes are dissected from the vaginal cuff, eliminating these steps from the following robotic procedure. In an attempt to minimize risk of mesh erosion, a double-layered vaginal cuff closure is performed. Next, we begin the robotic portion of the procedure using the Da Vinci S Robotic System by Intuitive Surgical. We prefer a side-docking approach, which maximizes the surgical assistant's access to the vaginal manipulator and Foley catheter during colpopexy. The advantages of the previously completed vesicovaginal and rectovaginal dissections are visualized robotically. The key steps of the colpopexy are then shown. CONCLUSION: Vaginal hysterectomy before robotic colpopexy should be considered in select candidates to save time, improve safety, and increase surgical teaching volume in academic urogynecology practices.