Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse

To describe and demonstrate the use and benefit of robotic-assisted laparoscopic sacrocolpopexy in the treatment of posthysterectomy vaginal vault prolapse. The procedure combines the use of standard laparoscopy with the daVinci robotic system. The patient is placed in the dorsal lithotomy position. One camera port, two robotic ports, and two standard laparoscopic ports are placed transperitoneally. Standard laparoscopic dissection, in combination with an intravaginal retractor, is used for initial anterior and posterior vaginal mobilization and exposure of the sacral promontory. The daVinci robot is then docked and used to suture a silicone Y-shaped graft from the vagina to the sacral promontory. Culdoplasty, with plication of the uterosacral ligaments, is then performed, with the final step, retroperitonealization of the graft. A total of 5 women have undergone this procedure, 3 with concomitant pubovaginal sling placement. All 5 women were discharged after 24 hours. No complications from the sacrocolpopexy were reported; however, 1 patient experienced transient vaginal bleeding related to the pubovaginal portion of the case. No recurrent anterior, posterior, or apical prolapse has occurred at mean of 4 months of follow-up. Using a robotic system for laparoscopic sacrocolpopexy facilitated precise intracorporeal suture placement so that the procedure could be done in a fashion similar to that of the open method. Robotic-assisted laparoscopic sacrocolpopexy may provide the same long-term durability of open sacrocolpopexy with the benefit of a minimally invasive approach.