Presented by: Tonya S. King PhD
Sarasota Memorial Health Care System

Introduction

Robotic sacrocolpopexy with uterus preservation (RASCP-UP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and preserves female sexual organs. Although hysterectomy may be performed at the time of POP repair, many women choose to preserve their uterus for reasons of sexuality, female identity, religion, maintenance of maximal vaginal length and undisturbed vaginal blood supply, and resistance to removal of a normal organ.   

Materials

Data was collected from an IRB-approved prospectively maintained database of robotic POP repair in a tertiary care hospital. The surgery was performed with a da Vinci Si or Xi system with 4 robotic ports and 1 assistant port. Commercially available 4 x 24 cm Y-shaped wide pore polypropylene mesh was modified to accommodate >10 cm anterior and posterior dissections of the vaginal walls. The anterior vaginal wall component was brought through the broad ligament and joined with the posteriorly placed component for attachment to the anterior longitudinal ligament with GoreTex sutures. The mesh was then completely covered by peritoneum. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP-UP had stage 4 prolapse with maximal anterior, posterior, and apical descent with the cervix at the apex of the descent. All patients had normal Pap smears and pelvic ultrasounds.  

Results

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Between 2010 and 2022, a total of 450 patients underwent RASCP at the same institution. Of these, 65 presented with complete vaginal vault eversion requesting RASCP-UP. Mean age was 65.9 years and mean BMI was 28.0. Cases were completed with robotic console time between 59 and 123 minutes and all patients were discharged within 24-48 hours. At mean 78-month (12 – 140 month) follow-up, there were no mesh erosions, hernias, or reoperations for prolapse. There was one reoperation for a hysterectomy at 6-year follow-up for suspected endometrial carcinoma and two reoperations for small bowel obstruction in patients with extensive lysis of adhesions. 

Conclusion

RASCP-UP is feasible for patients with severe POP who desire uterus preservation. The surgery restores normal vaginal axis and length without placement of mesh material through vaginal mucosa. Long-term results show durable functional repair. Women presenting with vaginal vault eversion and maximal descent of cervix can undergo repair of pelvic floor prolapse with concomitant hysterectomy. 

Funding

None.

Lead Authors

Genesis G. Dolgetta, BS
Sarasota Memorial Health Care System Research Institute

Robert I. Carey, MD, PhD
Sarasota Memorial Health Care System

Co-Authors

Benjamin J. Behers, MD
Florida State University College of Medicine

Maximilian S. Carey,
Sarasota Memorial Health Care System Research Institute

Karim Ghazli,
Sarasota Memorial Health Care System

Victoria Y. Bird, MD
Urologic Integrated Care