Assessment of the durability of robot-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse

Abstract

Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the definitive treatment option for post-hysterectomy vaginal vault prolapse. It is, however, associated with greater morbidity than vaginal repair. We describe a minimally invasive technique for vaginal vault prolapse repair and present our experience with a minimum of one-year follow-up. The surgical technique involves five laparoscopic ports-three for the da Vinci robot and two for the assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the vaginal apex by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy vaginal vault prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months follow-up, with a mean follow-up of 36 months (range 12-48) in the group. Mean age was 67 (47-83) years and mean operating time was 3.1 (2.15-4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent vault prolapse, and two suffered from vaginal extrusion of mesh. All patients were satisfied with their outcome. The robot-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient satisfaction, with a minimum of 1-year follow-up. Most importantly, the long-term results of the robotic repair are similar to those of open repair, but with significantly less morbidity.

Keywords: Laparoscopy; Robotics; Sacrocolpopexy; Vaginal vault prolapse.

Fig. 1

Standard laparoscopic port placement for the robot-assisted laparoscopic sacrocolpopexy. The laparoscopic ports are the 10 mm right subcostal port and the 5 mm port inferior laterally. The robotic ports are the paraumbilical camera port and the two 8-mm working ports lateral to the rectus muscle superior to the iliac crest

Fig. 2

The hand-held vaginal retractor (patent pending) used to facilitate dissection between the bladder and vagina

Fig. 3

The polypropylene Y-graft is used to tack the vaginal vault to the sacral promontory

Fig. 4

Comparative operating time of robot-assisted laparoscopic sacrocolpopexy