Robotic Repair of Vaginal Prolapse Holds Significant Benefits

Robotic surgery for vaginal prolapse dramatically reduces patient hospital stay and recovery time, according to a new study.

Researchers at the Mayo Clinic (Rochester, MN, USA) followed 48 women with symptomatic high-grade post-hysterectomy vaginal vault prolapse who underwent robotic sacrocolpopexy (vaginal wall repair), between 2002 and2008. The researchers monitored the patients for three years to evaluate the success rate of the procedure. The procedures were performed by a single surgical team, and there was clear evidence of a learning curve, with significant improvement in mean operative time, erosion rate, and recurrence rate with each group of 12 cases, compared with the preceding group. Mean operative time decreased from 3.8 hours for cases 1-12 to 2.5 hours for cases 37-48. The researchers found that overall, better outcomes were achieved in robotic sacrocolpopexy patients than in traditional surgery patients, which included less-invasive surgery, less time in the operating room, fewer postoperative complications, a shorter hospital stay, and faster postoperative recovery and return to work or normal activities. The study results were presented at a meeting of the North Central Section of the American Urological Association (AUA), held during November 2009 in Scottsdale (AZ, USA).

"Traditional abdominal sacrocolpopexy is a very durable procedure, but recovery is long and sometimes dissuades women from having surgery,” said senior author and study presenter Daniel Elliott, M.D., an associate professor in the department of urology. "This new robotic surgery is a major improvement and offers more options for women who want to have their prolapse repaired and are looking for a less-invasive type of procedure.”

In vaginal prolapse, pelvic organs, such as the uterus, rectum, bladder, urethra, and small bowel, or even the vagina itself, descend from their usual positions because of weakened support structures. Postmenopausal women who have had one or more vaginal deliveries are particularly at risk because of damage to supportive tissues during pregnancy and childbirth, the effects of gravity, loss of estrogen, and repeated Valsalva maneuver, resulting in weakened pelvic floor muscles and tissues. If untreated, the prolapsed structures can descend further into the vagina or even through the vaginal opening.

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