Robotic/laparoscopic sacrocolpopexy

Abstract

The demand for surgical correction of pelvic organ prolapse is expected to grow as the population ages yet remains active and focused on quality of life. Definitive correction of pelvic organ prolapse can be accomplished through both vaginal and abdominal approaches. Patient factors and preferences as well as surgeon experience and comfort often dictate the nature and extent of the repair. While there is no universally accepted “ideal” approach, the preponderance of data cites the superiority of abdominal sacrocolpopexy (ASC) in the durable correction of apical and multicompartment prolapse. Unfortunately, the “gold standard” open ASC is comparatively morbid and both patients and providers have trended toward transvaginal reconstruction, particularly during the era of seemingly simplistic “mesh-based kits.” The application of robotics and the pervasive concern regarding the transvaginal placement of synthetic mesh have revitalized and emboldened sacrocolpopexy. This chapter serves as a contemporary reference that specifically addresses the rationale, diagnostic algorithm, and therapeutic options for the treatment of female pelvic organ prolapse. Emphasis will be placed on the role and technique of abdominal-based reconstruction using a minimally invasive approach.