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Robot-Assisted Sacrocolpopexy Returns Patient to Active Lifestyle

May 2016

Contributed by Nissrine A. Nakib, MD

Sacrocolpopexy, an established surgical procedure for addressing pelvic organ prolapse, can now be conducted via a robot-assisted laparoscopic approach. For patients with apical pelvic organ prolapse, this supracervical laparoscopic approach offers a new minimally invasive surgery option. The procedure can be performed in the same setting as supracervical robotic-assisted hysterectomy. Here we report the successful surgical management of pelvic organ prolapse in a very active woman whose symptoms were interfering with her ability to exercise strenuously and with her sexual function.

Patient

A 41-year-old, very active female presented to University of Minnesota Health Urology Clinic with a history of pelvic organ prolapse. She had previously been prescribed a pessary but noted that her pessary often became dislodged during daily activities, especially when running. She also complained of painful intercourse and urinary urgency.

Urology-Adult-Spec-May-2016-Case-Study
— Robotic-assisted sacrocolpopexy, conducted via systems like the one pictured, has gained in use in recent years. Randomized controlled trials indicate equal efficacy between robotic and laparoscopic approaches used for the procedure.4

Management and Outcome

Because conservative management with a pessary had failed and her symptoms were reducing her quality of life, we recommended that the patient undergo robotassisted laparoscopic supracervical hysterectomy and sacrocolpopexy. The procedure was successful, and the patient spent 1 night in the hospital to recover. She returned to work 2 weeks postprocedure. After 6 weeks, she was permitted to resume her exercise routine. At a recent 2-year follow up, the patient was very pleased with her outcome. She had resumed normal sexual activity and strenuous running and reported full resolution of her symptoms.

Discussion

About 200,000 women a year in the United States undergo some type of surgical management for symptomatic pelvic organ prolapse, with a reported overall complication rate across age groups of 18 to 28.8%.1 Some robot-assisted procedures, however, appear to improve upon these outcomes. In a meta-analysis of 13 studies examining patient outcomes after robot-assisted sacrocolpopexy, reoperation rates were reported to be 6.6% and the cure rate was 98.6%.2 A second meta-analysis of 27 studies published between 2006 and 2013 reported objective cure rates ranging from 84% to 100%. The skill and experience of the surgeon, the article authors note, are well correlated with improved outcomes and reduced risk of reoperation, owing to the time required to master robot-assisted sacrocolpopexy.3

References

  1. Shah AD, et al. The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:421-428.
  2. Hudson CO, et al. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Reconstr Surg. 2014;20:252-260.
  3. Serati M, et al. Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol. 2014;66:303-318.
  4. Alas AN, Anger JT. Management of apical pelvic organ prolapse.Curr Urol Rep. 2015 May;16(5):33. doi: 10.1007/s11934-015-0498-6.
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