Robotic surgical management of combined vaginal and rectal prolapse

Abstract

Pelvic organ prolapse is a dynamic disorder with up to 50% of parous females experiencing partial or complete prolapse of at least one pelvic organ during their lifetime. These patients can present with protrusion or prolapse from the rectum and/or vagina. In addition, many of these women have additional symptoms such as fecal incontinence, urinary incontinence, and pelvic pressure. Traditionally, treatment and repair of each organ dysfunction was performed individually by the appropriate surgical specialty. Currently, we support a multidisciplinary operative approach, which we believe offers superior outcomes. In addition, the use of minimally invasive techniques, including both laparoscopic and robotic techniques, is gaining popularity. Herein we detail the robotic combined sacrocolpopexy/rectopexy procedure and discuss the superior outcomes of a minimally invasive approach. While mesh is routinely implanted and is associated with increased anatomical success, the difference in outcomes of biologic versus synthetic material has yet to be elucidated. Further studies are also needed to better characterize the benefit of robotic versus laparoscopic approach and to assess the impact of mesh selection.