Robotic-assisted sacrocolpopexy is a type of surgery. It is done to repair pelvic organ prolapse. The surgery is done with special tools.
Your pelvis is a bowl-shaped cavity made of a set of bones in the lower part of your belly (abdomen). Within this area there are several organs. These include the uterus, the bladder, and the lower part of your intestines. Strong tissues help hold these organs in place. If the tissues weaken, one or more of these organs may drop down and press against or bulge into the vagina. This is called pelvic organ prolapse. One type of pelvic organ prolapse is called vaginal vault prolapse. This is when the upper part of the vagina folds down into the lower part. Or it may even push outside the vaginal opening. This can happen after a hysterectomy.
Robotic-assisted sacrocolpopexy is one type of surgery to repair this problem. It is done to pull up the tissues and move the organs back into place. It is a minimally invasive method. This means it uses smaller cuts (incisions) than a standard surgery. It’s done while you’re asleep under general anesthesia.
During the surgery, your doctor will put small tools and a tiny camera through small incisions on your lower belly. This gives your doctor a better view of the area in your body. Your doctor moves the tools using a robotic controller. This lets your doctor do very small and precise movements with the tools. A graft of tissue or synthetic mesh is sewn onto the pelvic organs that have prolapsed. The graft is then attached to a bony area at the lower part of the spinal column. This helps keep the pelvic organs in place. The tools are then removed. The incisions are closed and bandaged.
Robotic-assisted sacrocolpopexy has some benefits over other methods. It may have a lower risk of complications for some people. It can lead to a shorter hospital stay and a faster recovery time.
This surgery may not be available in all areas. Robotic surgery is often more expensive than other methods. It can take longer than other types of surgery. Your healthcare provider can help you decide which surgery will work best for you.
Robotic-assisted sacrocolpopexy can help relieve the symptoms of pelvic organ prolapse, such as:
- Fullness or pressure in the vagina
- A bulge in the vagina or tissue bulging out from the vagina
- Leaking urine when you cough, sneeze, or laugh
- Sudden urges to urinate
- Pain with sexual intercourse
Pelvic organ prolapse can sometimes be treated without surgery. These treatments can include pelvic floor exercises or the use of a pessary. A pessary is a small device inserted into the vagina to provide support. Your healthcare provider may advise surgery if these options don’t work, or if you have moderate to severe prolapse. Your provider may advise you to have the surgery only if you don’t plan to have children in the future.
If you decide to have surgery, you may have certain options. For example, some women choose to have their uterus removed (hysterectomy) as part of their surgery. The best type of surgery for you may vary depending on the severity and location of your prolapse. Your provider can help you decide which type of surgery may be best for you.
Every surgery has risks. The risks of this procedure include:
- Excess bleeding
- Blood clots that can travel to the lungs and cause breathing problems
- Injury to nearby organs such as the bowel or ureters
- Wound healing problems
- Pain during sexual intercourse
- Inflammation in the vagina if mesh is used
- Reaction to anesthesia
- Failure of the organs to stay in place
- Return of prolapse symptoms
- Movement of the mesh
- Need for more surgery
Your risks may vary depending on your age, your overall health, and the severity and type of your prolapse. Before the surgery, talk with your healthcare provider about all of your concerns.
Talk with your healthcare provider how to prepare for your surgery.
- Tell your provider about all the medicines you take. This includes over-the-counter medicines such as aspirin and all prescription medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some medicines before the surgery, such as blood thinners.
- If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your provider if you need help to stop smoking.
- Don’t eat or drink after midnight the night before your surgery.
- Tell your provider about any recent changes in your health, such as a fever.
- Follow any other instructions from your provider.
You may need to have tests before your surgery, such as:
- Electrocardiogram, to evaluate your heart rhythm
- Chest X-ray, to assess your heart and lungs
- Urine sample, to test for infection and other factors
- Blood tests, to check for infection, anemia, and kidney function
Your healthcare provider can help explain the details of your surgery. An obstetrician/gynecologist (ob-gyn) surgeon or a urology surgeon will perform your surgery. He or she will be helped by a team of specialized nurses. In general, you can expect the following:
- You will be given general anesthesia. This prevents pain and causes you to sleep through the surgery.
- A healthcare provider will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.
- You may be given antibiotics before and after the surgery. This is to help prevent infection.
- The surgeon will make a few small incisions on your lower abdomen.
- The surgeon will pass tools through the small incisions. These include a tiny camera with a light, and several robotic tools.
- Your surgeon will use the robotic controller to move the tools to complete the different parts of the surgery.
- If you are going to have a hysterectomy, the surgeon will remove your uterus first. In some cases your provider and you decide to leave a part of your cervix in place. This may decrease the complications for the procedure.
- The surgeon will then lift up the prolapsed part of your vagina.
- A graft of tissue or synthetic mesh is sewn onto the pelvic organs that have prolapsed. This helps keep them in place. The graft or mesh is anchored with stitches to strong tissue in the pelvic area, usually a bony area at the base of the spinal column.
- Additional steps may be done to repair a prolapsed rectum, bladder, or other tissues.
- When the surgery is done, the tools will be removed. The incisions will be closed and bandaged.
After the surgery, your vital signs will be watched. You may need to stay overnight in the hospital. When you’re ready to go home, you’ll need to have someone drive you.
You may have some pain after the surgery. You can have pain medicine as needed. You can resume a normal diet as soon as you are able to.
Moving around as soon as possible after surgery can help prevent problems such as blood clots. You may need to do breathing therapy to help expand your lungs after surgery.
You may also have some fluid leaking from the incisions. Tell your provider if there is a lot of fluid, or the incisions are red or warm. Call your provider right away if you have a fever, heavy bleeding, severe pain, trouble breathing, or other severe symptoms.
Follow all of your provider’s instructions about wound care and medicines. Limit your movement and sexual activity as advised. You might need to have stitches removed at a follow-up appointment. Make sure to go to all of your follow-up appointments.
Your prolapse symptoms may go away completely after surgery. Talk with your provider if your symptoms do not go away, or if they return.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Goodman, Howard, MD , Goode, Paula, RN, BSN, MSN