Robot-assisted sacrocolpopexy for uterine or vaginal vault prolapse

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Robot-assisted sacrocolpopexy for uterine or vaginal vault prolapse

By JENNIFER MARIE B. JOSE, MD

Evelina, 76, had what is called a prolapsed vaginal vault. This condition caused Evelina’s vagina to sag out from her vaginal canal, leaving a mass of flesh hanging in between her legs.

The problem caused the septuagenarian a lot of pain and a feeling of heaviness in her pelvis and abdomen. Because a wad of flesh hung in between her legs, it caused her a lot of discomfort, which resulted to difficulties in such mundane tasks as standing or walking. The condition was also progressive. It started with pelvic pressure and lower abdomen discomfort then later caused her constipation and urinary incontinence or difficulties in holding back her urine. Evelina had to endure these symptoms for several years.

Other women who have prolapsed vaginal vaults, also often experience soreness in their vaginal tissues, which could in turn lead to bleeding. For younger women, the condition gives them difficulties in engaging in sex as it results to pain during sexual intercourse. The hanging flesh also caused uneasiness to their partners as the mass of vaginal tissues got in the way of the sexual act.

For some women, this is a cause of embarrassment or shame when they are with their partners because the prolapsed vaginal vault can be unsightly. Prolapse occurs when the connective tissues or muscles within the body cavity are weak. This results to the pelvic structures like the vagina to be displaced from its natural position. This causes the vagina to give in and jut out.

More often, older women, women who have undergone hysterectomy, those who have just had a child, obese women, and those engaged in strenuous physical labor are prone to prolapse.

Open surgical sacrocolpopexy

Evelina was given two choices to correct her condition either via open or robotics-assisted sacrocolpopexy surgery.

Sacrocolpopexy is a surgical technique that involves suspending the vaginal vault using a surgical mesh to the ligament of the sacrum or the bone at the base of the spine. This is to restore the natural anatomic position of the vagina and to keep it in its proper place.

Evelina was told that the open surgery would require a 15-20 cm horizontal incision on the lower abdomen in order to manually access the pelvic organs, including the uterus and also the base of the spine. The incision would run across below the navel to the area above the pubic region. This is a very invasive procedure that requires cutting across muscles, tissues and nerves that makes women prone to blood loss, infections, and most especially longer recovery period. The incision also results to scarring, usually below the navel to the area near the pubic bone.

Robotic sacrocolpopexy Evelina weighed her options carefully. Given her advance age, she thought it best to undergo the robotic-assisted sacrocolpopexy at St. Luke’s Medical Center-Global City. The developments in surgical technology and the invention of robotic surgical tools like the da Vinci Si Surgical System have made sacrocolpopexy a safer and more precise procedure. Currently, only St. Luke’s Medical Center in Global City has the most advanced da Vinci Si Surgical System in the country.

To carry out the surgery, tiny 1-2 cm incisions were made on her abdomen where the arms of the robot with surgical tools on their end were inserted.

The use of the da Vinci Si has made Evelina’s surgery much safer because surgeons had a better view of the organs being operated on with the 3-D video images it produces. This allowed her surgeons unimpeded view of the small space inside her pelvis. The small hands of the robot also allowed the doctors to move around the very tight and small spaces to operate with greater precision and control.

All these minimized the pain and risk associated with large incisions while increasing the likelihood of faster recovery and producing excellent clinical outcomes.

For most women, the da Vinci Si-assisted Sacrocolpopexy offers numerous potential benefits over the traditional open approach. These include significantly lesser pain, less blood loss and therefore lesser need for transfusions, reduced risk of infection, minimal scarring (normally four small, almost imperceptible scars), and shorter hospital stay and recovery time.

In fact, Evelina stayed in the hospital only for a day. And within a week after her surgery, she was back to doing her normal activities.

The grandmother is very happy that the discomfort that came with her prolapsed vaginal vault is now a thing of the past.

 

The Philippine Star       17 Dec 2012