Sacrocolpopexy

Sacrocolpopexy is a surgical procedure performed to treat pelvic organ prolapse. Pelvic organ prolapse is a very common problem, affecting one in nine woman. Pelvic organ prolapse is when organs slide from their natural positioning in the body and protrude into the vaginal canal or outside the vaginal opening.

Patients with prolapse can often have bladder control problems. These are evaluated and treated at the same time as the prolapse.

Causes

The primary cause of pelvic organ prolapse is weakened pelvic muscles and connective tissues, however, other causes can include:

• Vaginal deliveries
• Increase in chronic abdominal pressure, such as coughing, constipation, heavy exertion at work
• Genetics
• Obesity
• Smoking
• Hysterectomy

Symptoms

Symptoms of pelvic organ prolapse can range from mild to debilitating, affecting a person’s quality of life. Symptoms include:

• Sense of vaginal bulge
• Sense of pressure, heaviness
• Feels worse while on feet, better when laying down
• Rarely painful, but often a feeling of chronic discomfort

Treatment Options

Symptomatic prolapse can be treated by a vaginal pessary, which is a non-surgical treatment option. A pessary is a rubber device inserted into the vagina that supports the pelvic floor. The most common treatment option for pelvic organ prolapse is surgery.

For mild to moderate prolapse, surgery is often performed vaginally with traditional gynecologic techniques using sutures and a patient’s own tissue to correct the problem. Another surgical treatment option is placement of trans-vaginal synthetic mesh. The mesh is used to create a new pelvic floor to support the prolapsed organs.

For moderate to severe prolapse, physicians perform a sacrocolpopexy. Sacrocolpopexy is considered the most effective treatment option for prolapse, and has been deemed the ‘gold standard’ of care. Sacropolpopexy has been traditionally performed as an open surgery with a four-inch incision. While the success rate is high, the recovery time can be long.

Another approach, laparoscopic sacrocolpopexy, offers a minimally invasive alternative to open surgery. However, this treatment option is generally considered to be technically challenging due to the extensive suturing and dissection required and the limitations of laparoscopic technology.

The preferred treatment option of Hoag’s Gynecologic Robotic Surgery team is robotic-assisted sacrocolpopexy. Robotic-assisted sacrocolpopexy is best utilized for detive Apical dominant prolapse patients. Robotic surgery offers many benefits to women who are candidates, including:

• More supportive to top half of the vagina
• Less pain during intercourse
• Mesh more durable than patient’s tissue, proven over time
• Less mesh complications
• Restores more natural vagina anatomy
• Significantly less post-operative pain
• Less blood loss
• Shorter hospital stay
• Shorter recovery