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Video: Robotic Sacrocolpopexy

Magtibay, P M.; Hilger, W S.

Journal of Pelvic Medicine and Surgery: 2005 - Volume 11 - Issue - p S55
doi: 10.1097/01.spv.0000179331.89529.7a
Video Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society

Mayo Clinic, Scottsdale, AZ

Disclosure – Nothing to disclose.

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CLINICAL PROBLEM:

Laparoscopic sacrocolpopexies may reduce the morbidity of the procedure compared to the open technique but requires significant technical skill.1

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SURGICAL SOLUTION:

Our institution was the first to publish data on robotic sacrocolpopexy using a Da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA).2 The robot may decrease the difficulty of the procedure by providing 6 degrees of laparoscopic freedom for the operator, improving optics and decreasing tremor.

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METHODOLOGY:

This video discusses our robotic sacrocolpopexy technique. The video will describe the patient positioning, port placement and docking of the robot. The preparation of the mesh to facilitate laparoscopic placement and use of the robotic instruments for dissection and suturing will be explained.

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OUTCOME:

The patient was a 67-year-old female with a prior vaginal hysterectomy who presented with complaints of a vaginal bulge. On exam the patient was noted to have a POP-Q Stage III prolapse (point C at +2). The patient underwent a diagnostic laparoscopy, robotic bilateral salpingo-oophrectomy, robotic sacrocolpopexy and vaginal posterior colpoperineorrhaphy. The total procedure time was 3 hours and 2 minutes. The total OR time included 6 minutes docking time, 1 hour and 58 minutes console time for bilateral salpingopherectomy and sacrocolpopexy. The remaining 58 minutes included open laparoscopic port placement, removal of laparoscopic ports, de-docking the robot, and posterior colpoperineorrhaphy. Estimated blood loss was 50 cc and postoperative hemoglobin was 10.2. The patient was discharged on postoperative day 1. At her 6-week checkup good support of the vaginal vault was noted and point C was at −4.

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CONCLUSIONS:

The robotic sacrocolpopexy is feasible. The robot provides increased degree's of freedom for the laparoscopic surgeon that may simplify complex tasks like laparoscopic suturing and intracorporeal knot tying. The robot may decrease OR time and make this complex laparoscopic procedure possible for the gynecologist with less laparoscopic experience. More research needs to be done to prove the advantages and general applicability of robotic sacrocolpopexy.

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REFERENCES

1.Paraiso MFR, Walters MD, Rackley R, et al. Comparison of laparo-scopic and open sacral colpopexies. 2004 AUGS/SGS Joint Scien-tific Meeting. July 29–31, 2004; San Diego, CA.
2.Elliott DS, Frank I, DiMarco DS, et al. Gynecologic use of roboti-cally assisted laparoscopy: sacrocolpopexy for the treatment of high-grade vaginal vault prolapse. Am J Surg. 2004;188:52S–56S.
© 2005 Lippincott Williams & Wilkins, Inc.