Supracervical robotic-assisted laparoscopic sacrocolpopexy for pelvic organ prolapse

Abstract

Background: Supracervical robotic-assisted laparoscopic sacrocolpopexy (SRALS) is a new surgical treatment for pelvic organ prolapse that secures the cervical remnant to the sacral promontory. We present our initial experience with SRALS in the same setting as supracervical robotic-assisted hysterectomy (SRAH).

Methods: Women with vaginal vault prolapse and significant apical defects as defined by a Baden-Walker score of greater than or equal to 3 who had not undergone hysterectomy were offered SRALS in combination with SRAH. A chart review was performed to analyze operative and perioperative data. Outcome data also included patients who underwent robotic-assisted laparoscopic sacrocolpopexy (RALS) without any other procedure.

Results: Thirty-three patients underwent RALS, including 12 patients who underwent SRALS. All SRALS were performed following SRAH in the same setting. The mean follow-up for the RALS and SRALS patients was 38.4 months and 20.7 months, respectively. One patient in the RALS group had an apical recurrence. There were no recurrences in the SRALS group.

Conclusions: SRALS is effective for repair of apical vaginal defects in patients with significant pelvic organ prolapse who have not undergone previous hysterectomy. Complications are few and recurrences rare in short- and medium-term follow-up. Greater follow-up and numbers are needed to further establish the role of this procedure.

Figure 1.

Dissection of and 2-0 permanent monofilament suture placement into sacral promontory.

Figure 2.

Fixation of Y-graft arm to posterior aspect of cervical stump with 2-0 polyglactin suture.