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

Introduction

Robotic sacrocolpopexy (RASCP) is a transabdominal approach for repair of pelvic organ prolapse (POP) that avoids placement of transvaginal mesh and provides durable repair of high-grade prolapse. Given that the procedure has a trans-peritoneal component, there is a risk of reoperation due to small bowel obstruction (SBO).

Materials

Data was collected from an IRB-approved prospectively maintained database of RASCP 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 by a single surgeon.  Commercially available 4 x 24 cm Y-shaped wide pore polypropylene mesh was modified to accommodate the anterior and posterior dissections of the vaginal walls and were attached with running barbed suture with 16-20 sites of fixation. The long Y-arm of the mesh was trimmed to size for attachment to the anterior longitudinal ligament with GoreTex sutures. Posterior peritoneal flaps were created, and the entirety of the mesh and repair was completely covered by peritoneum. No mesh or suture was left exposed. Mid-urethral slings were placed at the time of sacrocolpopexy to prevent de novo stress incontinence. All patients for RASCP had stage 4 prolapse. There were no conversions from robotic to open. 

Results

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Between 2010 and 2022, 450 patients underwent RASCP at the same institution. 80 (17.8%) involved extensive lysis of adhesions (ELOS) and 370 did not. At mean 78-month (12–140 month) follow-up, there were 8 (1.8%) reoperations for SBO. 6/80 (7.5%) patients with ELOS had reoperations for SBO.  Median age of SBO patients was 71.5 years vs 70.0 for non-SBO. Median BMI was 22.5 for the SBO patients compared to 26.3 for non-SBO.  Robotic console time was between 59 and 123 min.  Median procedure time for RASCP with MUS was 122 min for SBO patients and 124 for non-SBO. All 8 reoperations for SBO had previous abdominal procedures. In ELOS patients the risk of SBO was 7.5% and in patients without ELOS, the risk was 0.5%.

Conclusion

RASCP is a safe and durable surgery for repair of POP. Risk of reoperation for SBO is associated with concomitant ELOS. In ELOS patients the risk of SBO is 7.5% and in patients without ELOS, the risk is 0.5%. Although many patients presenting for RASCP have had previous abdominal operations, not all such patients require ELOS. For patients with histories of numerous prior bowel or abdominal surgeries who are at increased risk for ELOS at the time of RASCP, careful patient selection is recommended, and appropriate preoperative counseling suggested. 

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