The da Vinci Mode

By Riva Preil

Pelvic Organ Prolapse (POP), organ descent of the bladder, uterus, or rectum, is an all too common problem which affects many adult women.  There are several treatment approaches proposed by medical care providers, including physical therapy to strengthen the pelvic floor muscles that rest beneath and support the organs.  Should physical therapy alone not sufficiently reduce POP symptoms and discomfort, surgical intervention may be indicated.  However, there is a large debate within the medical community regarding what is the best surgery to perform.  Not all surgeries are created equally, and different surgeries use different materials to stabilize the pelvic floor (ex. sling vs. propylene mesh).  Women’s bodies respond differently to these variations, and some require a revision several years later if the prolapse returns.  In addition, open surgery itself puts the individual at risk of sustaining a vaginal or bladder injury during the procedure itself, and some women experience post-surgical complications such as bowel obstruction.

The traditional sacrocolpopexy procedure involves removal of the uterus followed by attaching the vaginal vault to the periosteum of the sacrum with polypropylene mesh.  This open procedure involves a vertical or horizontal abdominal incision above the pubic bone.  The incision is closed with dissolvable or removable stitches.  Fortunately, a recent study in Belgium discussed in European Urology (June 11, 2013) revealed promising results regarding a NEW technique.  The study compared the previously aforementioned technique with a minimally invasive robot-assisted sacrocolpopexy (RASC) procedure. The RASC procedure was performed with the da Vinci Surgical System (created by Intuitive Surgical Company) on 95 women between April 2006 and December 2011.  On average, the procedure took 101 minutes to perform, and at the 34 month follow up, only 4 women (4.2%) were still experiencing POP symptoms.  Only 10.5% of participants experienced urinary urgency symptoms after the surgery, all of which resolved naturally within several weeks post-surgery.  No new bowel or sexual dysfunction symptoms were reported.  Therefore, if a surgical route is indicated, speak with your doctor about whether this safe and effective approach is appropriate for you!

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