Sacrocolpopexy
Robotic Sacrocolpopexy
Surgeons may offer a variety of procedures to treat pelvic organ prolapse. One common type of prolapse procedure, sacrocolpopexy, effectively treats prolapse in approximately 90-95% of women who undergo this procedure.
Many structures in the pelvic floor help to support the uterus, vagina, bladder and rectum. When the supporting tissues in the pelvis weaken and one of these structures begin to fall through the opening, women develop bothersome symptoms of prolapse. In cases with larger prolapse, recurrent prolapse after a previous surgery, or in patients who have high risk of recurrent prolapse, physicians may recommend a sacrocolpopexy.
This surgery oriented in the early 1960's. Initially, surgeons used the patient's own fascia, strong tissue, to build a bridge between the vaginal wall and the vagina to hold the vagina and other pelvic organ in a more anatomically correct position. This was done through a large incision either between the belly button and pubic bone or a "bikini" incision. Although the surgery effectively treated the prolapse, it still recurred at a high rate.
In the 1990's, the use of a surgical mesh such as gore-tex or polypropylene improved the long term success rates but still required a large incision. At the same time, many surgeons began using simple laparoscopy to perform sacrocolpopexy, but this procedure required multiple surgeons and had long surgical times. With the introduction of robotic surgery to gynecology in the early 2000's, gynecologists began treating women with prolapse using the robot and sacrocolpopexy became a minimally invasive option for women with prolapse.
Sacrocolpopexy uses a strip of surgical mesh to support the vaginal walls. By resupporting the vaginal walls, the bladder, vagina and rectum get support and are returned to their normal location. The strip of mesh is attached to the front of the vagina where the bladder is, the back of the vagina where the rectum is and then the long arm of the mesh is attached to a strong ligament in the back of pelvis on the sacrum. During the surgery, the vaginal support is assessed to insure the prolapse is reduced. Other procedures such as hysterectomy, midurethral sling, posterior repair, perineoplasty and cystoscopy are commonly performed at the same time.