Pelvic Reconstructive Surgery
Approximately fifty percent of women who have experienced childbirth have varying degrees of pelvic organ prolapse that affect the vagina. Some of these conditions can include:
- Vaginal Prolapse. Where the top of the vagina loses its support and drops, this condition occurs most often with women who have had a hysterectomy. Vaginal Prolapse can cause include difficulty urinating, bowel function, painful intercourse, vaginal pain loss of bladder control and a feeling of heaviness in the vaginal area.
- Small Bowel Prolapse (Enterocele). A condition when the small bowel presses against and moves the upper wall of the vagina causing a bulge or hernia to form.
- Anterior Vaginal Prolapse (Cystocele). A bulge or cystocele forms on the front wall of the vagina and causes a loss of support to the bladder that rests on that area of the vagina. Symptoms can include incontinence, a feeling of pelvic heaviness or back pain.
- Posterior Vaginal Prolapse (Rectocele). A condition when the rectum bulges into or out of the vagina. May cause difficulty with bowel movements.
Proper diagnosis is essential in treating pelvic support conditions. Being open about symptoms with your physician is important in finding the exact cause. Depending upon your symptoms and the type or vaginal prolapse you are diagnosed as having, treatments can include special exercises, lifestyle changes, the use of pessaries, changes in diet and lifestyle, reconstructive surgery and obliterative procedures to narrow and shorten the vagina.
Vaginal Prolapse Treatment
In treating or repairing vaginal prolapsed apical suspensions are used to restore the support of the top of the vagina (vaginal vault). Procedures used include:
- Abdominal Sacral Colopexy (ASC) – performed through an incision in the abdomen either laparoscopically or robotically, ASC involves the use of graft material to reinforce the walls of the vagina by forming straps that, when attached to the ligaments overlying the sacrum, support and suspend the vagina over the pelvic muscles and backbone.
- Uteroscral or Sacropinous Ligament Fixation – this procedure involves suspending the vagina to a patient’s own uterosacral ligament or sacrospinous ligaments. Graft material can also be added to improve the durability of the repair.
Small Bowel Prolapse (Enterocele) Treatment
The surgical procedure to correct this condition is called a sacral colpopexy. The surgical procedure uses polypropylene or biologic grafts so as to close over the apex of the vagina and correct the bulge or herniation of the small bowel into the vagina. The procedure approaches the vagina intra-abdominally. It is a complicated procedure in which a Y shaped mesh is positioned over the apex of the vagina and re-suspended to the sacrum.
Anterior Vaginal Prolapse (Cystocele) Treatment
A cystocele repair elevates the anterior vaginal wall back into the body to support the bladder. This can be done either vaginally or through an abdominal approach at the time of a sacral colpopexy. In an anterior colporrhaphy, an incision is made in the front wall of the vagina. The vaginal skin is separated from the bladder wall behind it. The weak or frayed edges of the deep vaginal wall are found and the strong tissue next to edges are sutured to each other lifting the bladder and recreating the strong wall underneath it.
Since this part of the pelvic floor is subjected to significant pressure with each cough or when picking up heavy items, up to one third of women will develop recurrent anterior prolapse after an anterior colporrhaphay. To reduce this recurrence, a surgeon may use graft material over the repair to reinforce it.
Posterior Vaginal Prolapse (Rectocele) Treatment
If muscles at the vaginal opening are stretched or separated at childbirth, this condition can be corrected by a perineorrhaphy. It may also be corrected abdominally during a sacral colpopexy. To correct the vaginal bulge, a surgical procedure called an anterior colporrhaphy is performed to raise the back wall of the vagina back into the body to support the bladder.
A posterior coloporrhaphy is a procedure used to repair the rectal bulge that protrudes through the back wall of the vagina. In this procedure, an incision is made in the back wall of the vagina. The vaginal skin is separated from the rectal wall underneath. Once the weak or frayed edges of the deep vaginal wall tissue are identified, the strong tissue next to edges is sutured to each other to recreate the wall between the rectum and the vagina. Occasionally, a surgeon will use graft material to provide additional strength to the repair.
If your symptoms from pelvic prolapse are severe and affect your lifestyle, your doctor may recommend surgery. Prolapse surgery is also known as sacrocolpopexy. During the procedure, mesh is used to hold the affected pelvic organ(s) in their correct natural position. The procedure is not the same was what occurs during transvaginal placement of mesh.
Sacrocolpopexy can also be performed after a hysterectomy and can provide long-term support for the vagina.1
Why da Vinci® Surgery
If you are facing pelvic prolapse surgery, you may be a candidate for da Vinci Sacrocolpopexy. da Vinci surgeons make just a few small incisions instead of a large open incision – similar to traditional laparoscopy. The da Vinci System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your doctor to operate with enhanced vision, precision, dexterity and control.
As a result of da Vinci technology, da Vinci Sacrocolpopexy offers the following potential benefits when compared to traditional open surgery:
- Less blood loss1,2,3
- Shorter hospital stay1,2,3
- Small incisions for minimal scarring
As a result of the da Vinci technology, da Vinci Sacrocolpopexy offers the following potential benefits compared to traditional laparoscopy:
- Shorter operation4
- Less blood loss4
- Shorter duration with catheter4
Additional potential benefits of da Vinci Sacrocolpopexy include:
- Low rate of complications5,6
- High sexual function5
- Improved urinary, bowel, and pelvic symptoms5
State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. da Vinci – taking surgery beyond the limits of the human hand.
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Physicians have used the da Vinci System successfully worldwide in approximately 1.5 million various surgical procedures to date. da Vinci is changing the experience of surgery for people around the world.
Risks & Considerations Related to Sacrocolpopexy & da Vinci Surgery
Potential risks of any sacrocolpopexy procedure, including da Vinci Surgery, include:
- Bowel blockage2
- Painful urination4
- Urinary infection4
PN 1002187 Rev B 01/2014
- Geller EJ, Siddiqui NY, Wu JM, Visco AG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstetrics & Gynecology. 2008;112:1201–6.
- Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol. 2012 May;206(5):435.e1-5. Epub 2012 Feb 1.
- Hoyte L, Rabbanifard R, Mezzich J, Bassaly R, Downes K. Cost analysis of open versus robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012 Nov-Dec;18(6):335-9. doi: 10.1097/SPV.0b013e318270ade3.
- Seror J, Yates DR, Seringe E, Vaessen C, Bitker MO, Chartier-Kastler E, Rouprêt M. Prospective comparison of short-term functional outcomes obtained after pure laparoscopic and robot-assisted laparoscopic sacrocolpopexy. World J Urol. 2012 Jun;30(3):393-8. Epub 2011 Aug 20.
- Geller EJ, Parnell BA, Dunivan GC. Pelvic floor function before and after robotic sacrocolpopexy: one-year outcomes. J Minim Invasive Gynecol. 2011 May-Jun;18(3):322-7. Epub 2011 Apr 1.
- Elliott DS, Krambeck AE, Chow GK. Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol. 2006 Aug;176(2):655-9.
Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.
Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.
Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci Surgery. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer towww.davincisurgery.com/safety and www.intuitivesurgical.com/safety. Unless otherwise noted, all people depicted are models.
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