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Robotic Sacrocolpopexy

Robotic Sacrocolpopexy. Steven H. Berliner, M.D. Section on Urogynecology and Pelvic Reconstructive Surgery Wake Forest Baptist Medical Center. No Financial Disclosures or Conflicts of Interest. In 1985, a prestigious medical center listed the following course in its conference brochure:

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Robotic Sacrocolpopexy

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  1. Robotic Sacrocolpopexy Steven H. Berliner, M.D. Section on Urogynecology and Pelvic Reconstructive Surgery Wake Forest Baptist Medical Center

  2. No Financial Disclosures or Conflicts of Interest

  3. In 1985, a prestigious medical center listed the following course in its conference brochure: “Hysteroscopy – in search of an indication”

  4. “Robotic Sacrocolpopexy – in search of an indication”

  5. Indications for Sacrocolpopexy in Patients with Apical Support Defects • Ideal in patients who are sexually active • Poor tissue quality (age, hypoestrogenic) • Shortened vaginal lengths/calibers • Prior MMK/Burch procedures • Previous failed repairs

  6. Contradictions • Active divertricular disease • Inflammatory bowel disease • Bleeding disorders (relative)

  7. Concerns • Cautious with patients who have had failed mesh procedures (anterior +/- posterior compartments) – overmeshed • Prior mesh infections – need to understand why? • High responders • Technique • Patients with prior repairs +/- mesh kits with vaginal pain/dyspareunia associated with stiffened anterior/posterior compartments – may worsen situation • May not correct level III defects – eversion of lower vagina

  8. Challenges in Performing Sacrocolpopexy - Open - Laparoscopic - Robotic • Elevated BMI • Variability of aortic/vena cava bifurcation • Elderly patients (degenerative vertebrae changes) – causes narrowing of bifurcation and bifurcation extending to L5-S1. Minimal space to attach graft to anterior vertebrae ligament • Prior pelvic/abdominal surgery • Bleeding, graft erosion, infection, rejection, sacral osteomyelitis, mesh shrinkage – back pain/vaginal pain

  9. Why Do Robotic Sacrocolpopexy? • Filters and translates hand movements into more precise movements of the endowrist movements • Target anatomy visualized at higher magnification (3-D) • Ergonomically superior • Ideal in areas (posterior vaginal wall-rectovaginal space) involving complex reconstruction and tight spaces • Small incisions, decreased operative pain, shorter hospital stays and return to activities faster

  10. Skill Sets for Doing Robotic Sacrocolpopexy • Reliance and experience from open/laparoscopic cases – haptics • Procedures typically take longer • Volume, volume, volume • Techniques – variability – surgical skill

  11. Not Everything Is for Everybody • Do what you know and are comfortable with • Follow your patients – over years • Learn from mistakes/errors • Diagnosis prior to going to the O.R. is key to a good repair • Sometimes lesser is better

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