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Collins, S. A.; Tulikangas, P. K.
Obstetrics and Gynecology, Division of Urogynecology, Hartford Hospital, University of Connecticut Health Center, Hartford, CT
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
The purpose of this video is to demonstrate advantages of performing hysterectomy at the time of robotic sacral colpopexy by the vaginal approach.
The video begins with a total vaginal hysterectomy performed on a woman with a stage 2 cystocele and a stage 2 uterovaginal prolapse. After the uterus and cervix are removed, the vesicovaginal and rectovaginal planes are dissected from the vaginal cuff, eliminating these steps from the following robotic procedure. In an attempt to minimize risk of mesh erosion, a double-layered vaginal cuff closure is performed. Next, we begin the robotic portion of the procedure using the Da Vinci S Robotic System by Intuitive Surgical. We prefer a side-docking approach, which maximizes the surgical assistant's access to the vaginal manipulator and Foley catheter during colpopexy. The advantages of the previously completed vesicovaginal and rectovaginal dissections are visualized robotically. The key steps of the colpopexy are then shown.
Vaginal hysterectomy before robotic colpopexy should be considered in select candidates to save time, improve safety, and increase surgical teaching volume in academic urogynecology practices.
Pelvic organ prolapse; Vaginal hysterectomy; Robotic colpopexy; Combined approach in prolapse surgery
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