Da Vinci Assisted Laparoscopic Sacrocolpopexy

Abstract

In Brief Objective: Report surgical technique and outcomes in patients who had da Vinci assisted laparoscopic sacrocolpoperineopexy (DLASCP) within a single urogynecologic surgical practice. Methods: Demographic data were collected by retrospective chart review for 77 consecutive patients who underwent DLASCP from May 2003 to October 2005. Postoperatively, subjective and objective outcome measures, including Pelvic Organ Prolapse Quantification staging, were recorded at 6 weeks, 6 months, and 1 year. Results: The mean follow-up was 7 months. Mean age and body mass index were 61.3 years and 26.1 kg/m2, respectively. Preoperatively, all the patients had stage ≥II prolapse. Preoperative urodynamic testing demonstrated urodynamic stress incontinence in 31 (40.3%), intrinsic sphincter deficiency in 10 (13%), detrusor overactivity incontinence in 9 (11.7%), and voiding dysfunction in 8 (10.4%) patients. The surgery was completed laparoscopically in 76 of 77 cases. Concomitant procedures included 33 midurethral slings, 65 rectocele repairs, and 3 vaginal hysterectomies. The median hospital stay was 2 days (range 2–10). Postoperatively, 4 patients required a procedure for stress incontinence. Overactive bladder was persistent in 1 patient and 15 (19.5%) developed de novo urge incontinence. Suture or mesh erosion occurred in 7 (9%) and 3 (4%) patients, respectively, of whom 3 required removal in the operating room. Only 1 patient had prolapse to the introitus by 1-year follow-up. Conclusion: DaVinci robotic system can be adjunctively used to facilitate laparoscopic sacrocolpopexy for patients with various stages of prolapse with good success rates and patient satisfaction. The da Vinci robot is a reliable technology that can be utilized to perform minimally invasive laparoscopic sacrocolpopexy with low conversion rate to laparotomy and low complication rates.