Background
Pelvic organ prolapse (POP) is a medical condition in which female pelvic organs, including the bladder, uterus, vagina, and/or rectum, descend from their normal positions within the pelvis.
These organs can sometimes protrude through the opening of the vagina. This condition is common, being symptomatic in approximately 30% of women 50-89 years of age and requiring a corrective procedure in 11% of women by 80 years of age.
POP occurs frequently with normal aging in women who have had vaginal delivery or deliveries or prior hysterectomy, and in those who have increasing body-mass index, which predispose these women to weakening of the supporting ligaments and muscles in the pelvic floor.
The prevalence of POP increases with age.
Researchers estimate that up to 250,000 surgical procedures to correct POP are performed each year in the United States,
and, as the proportion of older women continues to rise, the requirement for these procedures is expected to increase by approximately 50%.
Sacrocolpopexy is a surgical technique used to treat vaginal vault or uterine prolapse, 2 types of POP. The objectives of the procedure are to reduce prolapse and to restore the anatomy and function of the vagina. During the procedure, the apex of the vagina/fundus of the uterus or stump of the cervix is lifted back up to its natural position by attaching a synthetic mesh from the top and back of the vagina to the sacral promontory. The mesh provides the vagina with the right amount of support to keep it in the correct position (see the image below).
Diagram of the surgical mesh repair
No particular criterion standard for POP repair exists, yet the open abdominal mesh sacrocolpopexy has been revered as the main abdominal approach
for correction given its cure rates of 85-100% in recent studies.
However, when performed via a robotic-assisted laparoscopic (RAL) approach, the procedure is comparable in its clinical results, providing the same long-term durability of open sacrocolpopexy with the added benefits of a minimally invasive surgery, greater precision and control during the procedure, less pain, less blood loss, better cosmesis, and shorter hospitalization.
Many surgeons are unfortunately limited in their knowledge of how to skillfully perform sacrocolpopexies laparoscopically, but the assistance from a robotic system can significantly reduce the learning curve associated with laparoscopic sacrocolpopexy.