Page 40 - Jourmal of World Association of Laparoscopic Surgeon

10.5005/jp-journals-10033-1180
B Lavanya
REVIEW ARTICLE
Laparoscopic vs Robotic-assisted Sacrocolpopexy

B Lavanya

ABSTRACT the levator plate with the apex above the ischial promontory
and axis pointing toward the sacrum. Apex of the vagina or
Background: Laparoscopic sacrocolpopexy has been in vogue
1
since 1993. Robotic technique has started only since 2004. In cervix is attached to the anterior longitudinal ligament of
this article both the techniques are reviewed and an attempt is the sacral promontory with a prolene mesh.
made to discuss the advantages of each. Preoperative considerations include demonstration of the
Objective: Initially, a description of the procedure is given. Then, prolapse with magnetic resonance imaging (MRI)
the article will review the recent published studies on the colpocytogram in resting as well as straining position,
procedure, patient selection, intraoperative complications,
postoperative complications, recovery, postoperative pain, urodynamic studies where indicated, general evaluation of
quality of life and economic aspect of sacrocolpopexy performed morbidity factors considering the advanced age group of
laparoscopically and robotic assisted and discuss the merits of the patients, cardiovascular stability as long operative time
each.
and steep Trendelenburg position is required.
Materials and methods: Literature review conducted from X-ray of the sacral promontory is indicated by some
Google, PubMed, Springer Link, Highwire Press, da Vinci surgery
community. surgeons.
Conclusion: The minimal access approach offers reduced Laparoscopic Technique
morbidity, shorter hospitalization, and decreased postoperative
pain. The disadvantages of the laparoscopic approach Patient is placed in Trendelenburg position. Four ports are
compared to open include longer operating time and need for
advanced laparoscopic surgical skills including suturing. Robot- taken. The general abdominal cavity is explored.
assisted laparoscopic procedure allows the performance of Adhesiolysis is performed as required. If uterus is to be
complex laparoscopic maneuvers with less ergonomic difficulty, removed, it is done first by total or subtotal as decided.
and thereby simplifies the complex procedure but is currently Advantage of subtotal hysterectomy is that the cervix acts
4
expensive.
as an anchor for the mesh but of course the woman is
Keywords: Sacrocolpopexy, Laparoscopic sacrocolpopexy, instructed on the need to go for regular pap screening.
Robotic-assisted sacrocolpopexy.
If the procedure is done laparoscopically, in a patient
How to cite this article: Lavanya B. Laparoscopic vs Robotic- with intact uterus, it is pushed up with an elevator and the
assisted Sacrocolpopexy. World J Lap Surg 2013;6(1):42-46.
peritoneal fold of the bladder is dissected from the anterior
Source of support: Nil wall of the uterus. This causes the ureters to go below and
Conflict of interest: None declared thereby avoids injury. Then a paracervical buttonhole
window is made by opening the anterior layer of the broad
INTRODUCTION ligament and following it the posterior. This completes the
Increasing life span of the world population in general is anterior dissection.
supposed to increase the incidence of pelvic organ prolapse. Posteriorly, the peritoneum between the uterosacrals is
Currently the incidence of uterocervical prolapse is 11 to held and cut. The incision is extended over the peritoneum
2
14% and the incidence of vault prolapse is estimated to be of the uterosacrals to join the window made in the broad
1.3 for every 1,000 women. ligament. The peritoneum of the sacral promontory is cut
on the right side to the rectum and the anterior longitudinal
Symptoms ligament is exposed.
5
1. Seeing or feeling bulge or protrusion A Y-shaped prolene mesh is taken. Preformed mesh is
2. Pressure, heaviness not necessary. A 20 by 3 cm mesh is taken and cut in
3. Urinary incontinence, frequency and urgency: Manual Y-shape such that the long limb is 10 cm and both curved
reduction of prolapsed required to start or complete limbs 10 cm. The cervix is encircled with the curve of the
voiding. Y and sutures are placed attaching it to the anterior vagina.
4. Bowel symptoms: Incontinence, feeling of incomplete Anterior peritoneum is closed.
emptying, straining, digital evacuation, splinting. Posteriorly, the end of the vertical limb is sutured to the
5. Sexual symptoms: Dyspareunia, lack of sensation. 3 uterosacrals and posterior layer of the cervix. The first suture
Aim of the sacrocolpopexy procedure is to restore the is taken through the uterosacrals and mesh to lift the
vagina to the normal anatomical location where it lies over enterocele and attached to the vagina. The vertical limb is
42