We at GYN LA believe in providing the highest standard of compassionate care by implementing innovative and comprehensive gynecological treatments. We provide our services to women of any age and all over the greater Los Angeles area. We specialize in using the proprietary da Vinci Surgical System to help our surgeons give you the best care possible.
What is a Robotic Sacrocolpopexy?
Sacrocolpopexy is a type of operation to repair pelvic organ prolapse involving the uterus, cervix, or vagina. Pelvic organ prolapse frequently occurs in women who have had a hysterectomy. A hysterectomy is the most common kind of gynecological procedure and is performed on almost 30% of all women below the age of 60. It can be performed for a variety of reasons, though commonly it is performed due to pelvic or vaginal organ prolapse. There are various organs that may prolapse, including the bladder, uterus, vagina, bowels, and rectum. A prolapse is formally defined as the displacement or slipping down of an organ or part of the body. If it occurs specifically within a woman’s pelvis and reproductive system it is generally known as a cervical or vaginal prolapse.
Fiber optics have revolutionized surgical procedures in recent years. An instrument known as a laparoscope, essentially a slim piece of fiber optic cable with a camera, can be inserted in to the abdomen via a tiny incision. These tiny incisions are sometimes called “keyholes”. The surgeon can view the surgical site with a degree of detail without having to cut a large incision in to the patient’s abdomen. This allows for procedures which are exponentially less invasive than more traditional means.
A robotic sacrocolpopexy is a type of laparoscopic sacrocolpopexy that is even less invasive and is done using the highly advanced da Vinci Surgical System. This system takes the images gathered by the laparoscope, magnifies them and then renders them in three dimensions (3D) and high definition (HD) on a set of monitors. The surgeon can do the entire surgery without having to look away from the screens and all the while controlling the various surgical tools with extreme precision. Furthermore, this enhances the surgeon’s ability to be more accurate in the placement of suspension sutures, resulting in an incredibly high success rate with minimal complications.
A robotic sacrocolpopexy performed with the da Vinci Surgical System can successfully relieve the symptoms associated with pelvic prolapse, including:
- Uncomfortable pressure or fullness in the vagina.
- Uncontrollable and sudden urges to urinate.
- Incontinence, particularly when laughing, coughing, or sneezing.
- Tissue protruding from the vagina.
- Pain and discomfort during sexual intercourse.
- Severe and chronic constipation.
The success rate of robotic sacrocolpopexies performed with the da Vinci Surgical System is over 90% and the complication rate is under 5%. If complications do arise, the vast majority of them can be handled non-surgically, meaning no further operations will be necessary and they can be successfully managed using medication or outpatient treatment.
There are various benefits to having a robotic sacrocolpopexy versus a more traditional, open abdominal surgery. They include:
- A faster recovery for the patient, resulting in a shorter recuperation period at the hospital.
- Lower likelihood of any post-operative complications developing.
- Lower likelihood of post-operative or secondary infection developing, either at the incision site or elsewhere on the body.
- Lower loss of blood.
- Less need to prescribe narcotic painkillers as the procedure is less painful.
- Minimal scarring due to the incision being much smaller.
- Natural length and depth of the vaginal canal are maintained, allowing the patient to enjoy a healthy and robust post-operative sex life.
The da Vinci Surgical System allows the surgeon to operate with a greater degree of precision and to create less tissue damage or trauma. Any surgical procedure will necessarily result in some degree of tissue damage, but a robotic sacrocolpopexy is done with significantly smaller incisions. This results in far less trauma to the internal organs and tissues.
The da Vinci Surgical System is made up of a tower with four robotic arms, three of which contain surgical instruments and one of which contains the laparoscope. It also contains a console that has the master controls and various monitors for the surgeon to see the surgical site in HD, 3D, and with depth perception. The tower is placed over the patient with a surgical assistant present, an anesthesiologist monitoring the patient, and the primary surgeon stationed at the console. A secondary surgeon is sometimes present for more complex cases.
The surgical instruments attached to the three robotic arms are a patented technology known as EndoWrist. These are sophisticated instruments that mirror the highly specific movements of the surgeon’s hand and wrist. However, they are actually more flexible and have a higher range of motion than the average human hand and are approximately twice as dexterous.
During the robotic sacrocolpopexy, the surgery will generally proceed as follows:
- The patient will be given general anesthesia. This is to ensure that they remain unconscious during the procedure and do not experience any pain. An anesthesiologist will be present to monitor vital signs, such as heart rate, oxygen saturation, and blood pressure, and adjust levels of medication accordingly.
- Antibiotics will be administered before and after the surgery, generally intravenously, to decrease the likelihood of a secondary infection developing.
- A few small incisions, generally 1-2 centimeters long, will be made in the lower abdomen.
- The laparoscope and the EndoWrist instruments will be passed through the tiny incision.
- Using the master controls at the da Vinci Surgical System console, the surgeon will manipulate the laparoscope and instruments within the surgical site to the precise location where the sacrocolpopexy needs to be performed.
Sometimes a hysterectomy is necessary, so the surgeon will remove it first. However, the cervix is left intact.
The prolapsed part of the vagina will be lifted up. This is accomplished by installing a sling that uses the sacrum as a support structure. If there is a cervical prolapse, then a graft of tissue or a piece of polypropylene mesh is sewn in to the organs where the prolapse has occurred. This approximates the body’s natural ligaments and musculature that cause pelvic prolapse when they are damaged or weakened.
A medical-grade polypropylene cloth is used in the cases where the mesh is installed. This plastic mesh is divided into two strips that are identical in their dimensions and that are specifically tailored to the patient’s prolapse. One of the strips is sutured between the vagina and bladder while the second strip is sewn into the space between the vagina and rectum.
The polypropylene mesh is also attached to the sacrum. This is a triangular bone that is formed from fused vertebrae and lies directly between the two hipbones. In fact, the term “sacrocolpopexy” comes from “sacral”, meaning of or relating to the sacrum. The sacrum, in this case, essentially acts as an anchor or stabilizer for the prolapsed pelvis and provides a measure of stability as it is a bone.
If the patient also suffers from vaginal looseness due to the prolapse, the surgeon may also perform vaginal reconstructive surgery with the da Vinci Surgical System. During this portion of the procedure the musculature of the pelvic floor is raised and the vagina is tightened by rebuilding the perineum.
If there is a prolapsed rectum or other complications, further measures can be taken.
The tools are removed and the incisions are sutured up.
The extent of the surgery depends entirely on how serious the prolapse is. However, the basic concept of a robotic sacrocolpopexy is to use the da Vinci Surgical System to perform a minimally-invasive operation that restores the structural integrity of the pelvic organs and reverses any partial or complete prolapses that may have occurred.
What is the recovery time for a robotic sacrocolpopexy?
The recovery time for a more traditional, abdominal sacrocolpopexy can be as long as 6 to 8 weeks and can be quite intense for the patient to undergo. With a robotic sacrocolpopexy, the patient usually stays in the hospital for 1 night for post-operative evaluation and assistance in pain management. In general, patients only require tylenol and ibuprofen for pain control. Once the patient is discharged from the hospital, the recovery time takes approximately 2 weeks. This is roughly a quarter of the amount of time of a traditional abdominal sacrocolpopexy recovery period.
Once the patient has been discharged home, they should avoid heavy lifting or strenuous exercise for at least 6 weeks. Furthermore, swimming and sexual intercourse should also be avoided for at least 8 weeks. During the recovery, gentle walking is highly encouraged, starting with 10 minutes a day until the patient can work their way up to longer increments of time. It is generally recommended that the patient take 3 to 4 weeks off work to fully recover, and even longer if their job is a particularly physical one.
How long does it take to perform a robotic sacrocolpopexy?
A traditional, open abdominal sacrocolpopexy can take anywhere from 60 to 90 minutes. A robotic sacrocolpopexy usually takes 15 minutes longer, anywhere from 1.5 to 2 hours. However, the longer length of the operation does not translate in to a longer recovery time. On the contrary, a robotic sacrocolpopexy has roughly half the recovery time of a more traditional abdominal sacrocolpopexy.
Because the keyhole incisions in a robotic sacrocolpopexy are so small and inconspicuous, it takes longer to actually insert the laparoscope and various instruments of the da Vinci Surgical System. This is the primary reason why a robotic sacrocolpopexy takes longer. However, there is a greater level of precision and range of motion in the robotic surgery, allowing for a precise placement of sutures and support structures in the process of undoing the cervical prolapse. If the prolapse is severe, then the surgeon may have to spend a considerable amount of time installing the tools, usually via the vaginal canal, necessary to restore the vagina and cervix to its natural placement and function. Therefore, even if the robotic surgery takes longer, it has substantially more benefits than the more traditional approaches.
What are the side effects of a robotic sacrocolpopexy?
As with any operation, there is the risk of side effects or complications. On the whole, though, robotic sacrocolpopexy is an immensely safe procedure that is done frequently at highly qualified clinics like GYN LA. The most commonly cited complications are pain during intercourse (2 to 3% of the time), the polypropylene mesh in the vagina becoming exposed (2 to 3% of the time), and damage to the urinary or digestive tract (1 to 2% of the time). There is also a 1% chance of excessive bleeding and internal hemorrhaging during the operation; this is generally easily controlled by closely observing a patient’s blood pressure during the operation.
There is a very slight chance of deep vein thrombosis (DVT), a type of blood clot in the leg that can easily be managed by wearing special stockings and taking medications. There is also the potential of a secondary infection occurring, either at the incision site or within the patient’s body. It may even occur where the polypropylene mesh has come undone and caused inflammation in the patient’s reproductive system.
There is also the possibility that the patient will have an adverse reaction to the anesthesia. This usually occurs when the patient returns to consciousness and includes symptoms of:
- Double vision
- A temporary loss of memory
It is possible that the patient may have an adverse reaction during the procedure, but this is exceedingly rare as the patient is always under the observation of an anesthesiologist to monitor their vitals and oxygen saturation levels.
Find a Robotic Sacrocolpopexy Clinic Near Me
GYN LA is our gynecological medical clinic that is based in Los Angeles. We as a practice specialize in performing robotic sacrocolpopexies and have a fully trained staff to deal with any issue you may have. There is no challenge too great for us. Our practice is full of compassion, understanding, and innovation. Our medical care is always of the highest degree and quality. Let us help you and call 310-375-8446 today for a consultation or to speak to a representative.