Pelvic Organ Prolapse Surgery
Learn about pelvic organ prolapse repair and understand your options https://www.ncbi.nlm.nih.gov/pubmed/24142054
You deserve special care
The muscles and connective tissues supporting your pelvic organs (uterus, bladder, and rectum) can weaken, causing the organs to slip down (prolapse) from their usual positions. When pelvic organ prolapse occurs symptoms may include pressure or discomfort in your pelvic area, a bulge in your vagina, tissue moving out of your vagina, and urinary incontinence.1 Pelvic organ prolapse is surprisingly common. Between 3 and 6 percent of women notice symptoms, and vaginal examinations show that up to 50 percent of women have some degree of pelvic organ prolapse.2
To diagnose pelvic organ prolapse, your doctor may ask you for your medical history and may do a vaginal and rectal exam, either while you are laying down, standing, or both. You may be asked to cough during the exam to see if you leak urine and you may be checked to see how completely your bladder empties.3
Understanding your options
If you’ve been diagnosed with pelvic organ prolapse, your doctor may recommend a wait-and-see approach, lifestyle changes, exercises to strengthen the pelvic floor muscles, or a removable vaginal device that supports pelvic organs called a pessary.1 If none of these options provide adequate symptom relief, your doctor may recommend surgery. There are two types of surgery for pelvic organ prolapse: obliterative surgery and reconstructive surgery.1 Obliterative surgery narrows or closes off the vagina to provide support for prolapsed organs.
Reconstructive pelvic organ prolapse repair surgery aims to hold the organs in their correct locations. During surgery, the surgeon moves the organs back to their original positions and may implant a surgical mesh support to keep the organs from moving.
Surgeons can perform pelvic organ prolapse repair surgery using traditional open surgery, which requires a long incision (cut), or through minimally invasive surgery. In traditional open surgery, the surgeon looks directly at the surgical area through the incision and performs the repair using hand-held tools.
There are three types of minimally invasive approaches: vaginal, laparoscopic, or robotic-assisted surgery, possibly with da Vinci® technology. A vaginal surgery is when the entire procedure is done through the vagina and there are no incisions (cuts) on your abdomen. Doctors perform minimally invasive laparoscopic or robotic-assisted surgeries through a few small incisions in the abdomen. To perform a laparoscopic procedure, surgeons use special long-handled tools while viewing magnified images from the laparoscope (camera) on a video screen.
How da Vinci works
Surgeons can perform a type of pelvic organ prolapse repair called a sacrocolpopexy using da Vinci technology. With da Vinci, your surgeon sits at a console next to you and operates using tiny, fully wristed instruments.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
It’s important to remember that Intuitive does not provide medical advice. After discussing all options with your doctor, only you and your doctor can determine whether surgery with da Vinci is appropriate for your situation. You should always ask your surgeon about his or her training, experience, and patient outcomes.
Why surgery with da Vinci?
A review of published studies suggests that potential benefits of a pelvic organ prolapse repair (sacrocolpopexy) with da Vinci technology include:
- Patients may experience fewer complications compared to patients who had open surgery4,5 and a comparable complication rate to patients who had laparoscopic surgery.4,5,7,8
- Patients may stay in the hospital for a shorter amount of time compared to patients who had open surgery4 and similar, though sometimes shorter, amount of time compared to patients who had laparoscopic surgery.4,5,8,9
- With da Vinci, you may have a few small incisions compared to an open procedure and, after surgery, a few small scars.
All surgery involves risk. You can read more about associated risks of sacrocolpopexy repair here.
Questions you can ask your doctor
- What options are available to address my pelvic organ prolapse?
- What happens if I don’t get surgery?
- What are the differences between open, vaginal, laparoscopic, and robotic-assisted surgery?
- Can you tell me about your training, experience, and patient outcomes with da Vinci?
- How will I feel after surgery?
Resources for learning more
Pelvic organ prolapse brochure
Take away information about pelvic organ prolapse repair surgery using da Vinci technology in our brochure designed for patients and families.
Gynecologic surgery with da Vinci
Robotic-assisted surgery with da Vinci technology is used in many different types of procedures by gynecology surgeons.
1. Surgery for Pelvic Organ Prolapse. The American College of Obstetricians and Gynecologists. Web. 21 January 2019.
2. Barber, M.D., Maher, C., Int Urogynecol J. 2013 Nov;24(11):1783-90. doi: 10.1007/s00192-013-2169-9. https://www.ncbi.nlm.nih.gov/pubmed/24142054
3. Pelvic Support Problems. The American College of Obstetricians and Gynecologists. Web. 21 January 2019.
4. Serati, et al (2014). Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis of Comparative Studies. European Urology. 66:202-318.
5. Nosti, Patrick A., Uduak Umoh Andy, Sarah Kane, Dena E. White, Heidi S. Harvie, Lior Lowenstein, and Robert E. Gutman. "Outcomes of Abdominal and Minimally Invasive Sacrocolpopexy." Female Pelvic Medicine & Reconstructive Surgery 20.1 (2014): 33-37. Print.
6. Siddiqui, Nazema Y., Elizabeth J. Geller, and Anthony G. Visco. "Symptomatic and Anatomic 1-year Outcomes after Robotic and Abdominal Sacrocolpopexy." American Journal of Obstetrics and Gynecology 206.5 (2012): 435.e1-35.e5. Print.
7. Anger, et al (2014). Robotic Compared with Laparoscopic Sacrocolpopexy. A Randomized Controlled Trial. Obstetrics & Gynecology. 123(1)5-12.
8. Flack, et al (2015). National Trends in the Performance of Robot-Assisted Sacrocolpopexy. J Endourology Jul;29(7):777-83. doi: 10.1089/end.2014.0710. Epub 2015 Mar 10.
9. Paraiso, et al (2011). Laparoscopic Compared with Robotic Sacrocolpopexy for Vaginal Prolapse. A Randomized Controlled Trial. Obstetrics & Gynecology. 118(5)1005-1013.
Disclosures and Important Safety Information
Risks associated with sacrocolpopexy (pelvic prolapse surgery) include mesh erosion/infection caused by mesh moving from vaginal wall into surrounding organs causing the need for another operation, injury to rectum/bowel, injury to bladder (organ that holds urine), injury to the ureters (the ureters drain urine from the kidney into the bladder), front wall of the rectum pushes into the back wall of the vagina, prolapsed bladder (bladder budges into vagina when supportive tissue weakens), vaginal incision opens or separates, loss of bladder control, pooling of blood between bladder and pubic bone, pooling of blood between the anus and vagina.
Important Safety Information
Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision.
Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety.
Individuals' outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.
Da Vinci Xi® System Precaution Statement
The demonstration of safety and effectiveness for the specific procedure(s) discussed in this material was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.
Medical Advice and Locating a Doctor
Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Other options may be available and appropriate. Only a doctor can determine whether da Vinci Surgery is appropriate for a patient’s situation. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.
Surgeons who perform surgery using the da Vinci System can be found using the Surgeon Locator. Intuitive Surgical provides surgeons with training on the use of the da Vinci System but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.
In order to provide benefit and risk information, Intuitive Surgical reviews the highest available level of evidence on procedures named above. Intuitive Surgical strives to provide a complete, fair and balanced view of the clinical literature. However, our materials should not be seen as a substitute for a comprehensive literature review for inclusion of all potential outcomes. We encourage patients and physicians to review the original publications and all available literature in order to make an informed decision. Clinical studies are typically available at pubmed.gov.