|Minimally Invasive Laparoscopic Abdominal Sacrocolpopexy|
Abdominal sacrocolpopexy has been the gold standard procedure performed to correct prolapse of the vaginal vault (top of the vagina). Traditionally, an abdominal incision measuring 6-8 inches has been used to perform this operation. However, recent advances have allowed this same procedure to be performed via a robotic-assisted or laparoscopic approach resulting in smaller incisions, less postoperative pain, decreased hospitalization, and quicker overall recovery all while maintaining the same high success rates.
During the procedure, a piece of synthetic mesh is stitched to the top of the vagina and attached to a strong ligament overlying the back of the pelvic bone. The mesh is a permanent material (prolene) as are the sutures. The area between the bowel and the top of the vagina is often closed to prevent a hernia of the bowel from developing. The success rate for this procedure is approximately 90%. Other problems such as incontinence or prolapse of the bladder or rectum may also be fixed during the same anesthetic.
Many of the risks or side effects that may occur during or after a sacrocolpopexy are similar to the general risks of any major pelvic surgery such as heart attack, stroke, death, blood clots in the legs or lungs, excessive bleeding, infection, and the risks of anesthesia. These risks are typically very low and extensive measures are taken by your surgical team and doctors to minimize these risks. Other risks specific to sacrocolpopexy include but are not limited to injury to the bladder, urethra, ureters, major blood vessels or nerves, rectum/bowel, etc. Injury to most of these structures is exceeding uncommon. The risk of injury to the bladder is around 5% and may be increased by prior surgery that a patient has had. An injury to the bladder can usually be repaired without difficulty but does require the catheter to remain in place for several days after the operation to allow healing. Other risks also exist such as erosion of the mesh through the vagina, infection of the mesh requiring removal, problems with sexual intercourse, difficulty with emptying the bladder, leakage of urine or overactive bladder, and bowel problems. These problems, if they arise, can sometimes require further surgery. Any patient who undergoes a robotic or laparoscopic procedure must also always understand the small risk of possibly needing to covert to a larger “open“ incision. If there are significant adhesions from prior surgery or it is felt that the operation cannot be performed safely or effectively laparoscopically, your surgeon will not hesitate to make a larger incision to get you the best result.
Most patients will stay in the hospital one night. It is important to walk and you will be encouraged to do so the night of surgery to minimize the risks of blood clots. You also will be asked to perform deep breathing exercises to prevent to risk of lung problems or pneumonia. You will wake up from surgery with a catheter and sometimes a vaginal packing in place. The vaginal packing is usually removed the morning after surgery. The catheter is also usually removed the day after surgery and patients will undergo a voiding trial to make sure they can empty their bladder appropriately. If you are unable to empty your bladder prior to leaving the hospital, you will be taught how to catheterize yourself by the nursing staff before you are discharged home. If this occurs, it most commonly resolves within one-two weeks after surgery.