VIDEO ARTICLE Year : 2023  |  Volume : 12  |  Issue : 1  |  Page : 44-45

Robotic lateral pelvic organ prolapse suspension of multicompartment vaginal prolapse

Antonio Pellegrino1, Mario Villa1, Maria Cristina Cesana1, Anna Myriam Perrone2, Antonio Malvasi3, Vera Loizzi3, Pierluigi Giampaolino4, Ettore Cicinelli3, Pierandrea De Iaco2, Gianluca Raffaello Damiani3
1 Astt-lecco, Manzoni Hospital, Terziary Refferall Center, Teaching Hospital, Lecco, Italy
2 Division of Oncologic Gynecology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
3 Department Of Obstetrics and Gynecology, University of Bari, Policlinico of Bari, Italy
4 Department of Obstetrics and Gynecology, University of Naples, Federico2°, Italy

Date of Submission28-Jul-2021Date of Decision15-Nov-2022Date of Acceptance17-Nov-2022Date of Web Publication9-Feb-2023

Correspondence Address:
Dr. Gianluca Raffaello Damiani
Department of Obstetrics and Gynecology, University of Bari, 1°Clinic, Bari
Italy

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/gmit.gmit_97_21

How to cite this article:
Pellegrino A, Villa M, Cesana MC, Perrone AM, Malvasi A, Loizzi V, Giampaolino P, Cicinelli E, De Iaco P, Damiani GR. Robotic lateral pelvic organ prolapse suspension of multicompartment vaginal prolapse. Gynecol Minim Invasive Ther 2023;12:44-5
How to cite this URL:
Pellegrino A, Villa M, Cesana MC, Perrone AM, Malvasi A, Loizzi V, Giampaolino P, Cicinelli E, De Iaco P, Damiani GR. Robotic lateral pelvic organ prolapse suspension of multicompartment vaginal prolapse. Gynecol Minim Invasive Ther [serial online] 2023 [cited 2023 Feb 10];12:44-5. Available from: https://www.e-gmit.com/text.asp?2023/12/1/44/369420   Objective 

Sacrocolpopexy is associated with rare but serious morbidity. The technique was progressively modified.[1],[2],[3] The goal of our video is to highlight the robotic technique in a multicompartment prolapse of vaginal vault with lateral suspension. The patient was a 58-year-old female with multicompartment pelvic organ prolapse arose after hysterectomy.

  Design 

We further developed this technique with the da Vinci system which allowed us to avoid the transparietal passage of the mesh, avoiding potential damage to the ilioinguinal and iliohypogastric nerves. There was no standardized procedure.[4],[5],[6],[7],[8] Informed consent was obtained.

  Setting 

Manzoni Hospital, third referral center. All the crucial steps of our surgical approach were visualized. Position of the patient was described in our previous paper.[9],[10] After introducing the da Vinci 0° optic, we placed the two 8-mm trocars in each iliac fossa, laterally about 5 cm above and 2 cm medial to the anterior superior iliac spine.

  Interventions 

The procedure uses a titanized propylene prosthesis shaped in T that gives it maneuverability and elasticity proper to native tissues. The positioning technique involves a first phase of removing peritoneum from the vaginal dome and then the disconnect of the vescicovaginal band to delimit the mesh anchoring plans. The lateral trajectory of it consists to insert in a retrograde manner the side arm of the prothesis in the context of the lateral abdominal wall with a posterior projection to the anterior-upper iliac crest in a space which is free of major complications [Figure 1] and [Figure 2]. Procedure started with dissection of the cervicovesical pouch. The vesicovaginal space was then identified between the bladder and the anterior vaginal wall. A mesh (Endolas® 41.5 cm × 5 cm × 15 cm) with two lateral arms was tailored and fixed to the vagina, by six sutures of 2-0 polyglactin 910. The peritoneum of the vesicouterine fold was closed over the mesh.

Figure 1: The mesh with two lateral arms was tailored and fixed to the vagina after removing peritoneum from the vaginal dome

Click here to view

  Results 

Total operating time was 92 min. The patient was hospitalized for 2 days. At 2-year follow-up, no complications occurred. We organized the ward staff as described previously.[9],[10],[11]

  Conclusion 

Lateral colposuspension represents a new method, simple, effective, reproducible preferable in all cases where central dissection is not easy. Robotic approach remains the mainstay for benign pathology.[12]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
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    2.Ceci F, Spaziani E, Corelli S, Casciaro G, Martellucci A, Costantino A, et al. Technique and outcomes about a new laparoscopic procedure: The pelvic organ prolapse suspension (POPS). G Chir 2013;34:141-4.  
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    5.Vitale SG, Laganà AS, Noventa M, Giampaolino P, Zizolfi B, Butticè S, et al. Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality. Biomed Res Int 2018;2018:5727165. doi: 10.1155/2018/5727165. PMID: 29675427; PMCID: PMC5851336.  
    6.Pellegrino A, Damiani GR, Villa M, Sportelli C, Pezzotta MG. Robotic sacrocolpopexy for posthysterectomy vaginal vault prolapse: A case series of 31 patients by a single surgeon with a long term follow-up. Minerva Ginecol 2017;69:13-7.  
    7.Coolen AW, Bui BN, Dietz V, Wang R, van Montfoort AP, Mol BW, et al. The treatment of post-hysterectomy vaginal vault prolapse: A systematic review and meta-analysis. Int Urogynecol J 2017;28:1767-83.  
    8.Loverro G, Damiani GR, Loverro M, Muzzupapa G, Villa M, di Naro E. Surgical management of recurrence of multicompartment pelvic organ prolapse after failure of laparoscopic lateral POP suspension (LLPOPS): Initial report of six cases and outcomes at 2 years follow-up. Updates Surg 2020;72:225-7.  
    9.Pellegrino A, Damiani GR, Fachechi G, Pirovano C, Gaetani M, Youssef A. Cost analysis of minimally invasive radical hysterectomy for cervical cancer performed by a single surgeon in an Italian center: An update in gynecologic oncological field. Updates Surg 2017;69:517-22.  
    10.Damiani GR, Riva D, Pellegrino A, Gaetani M, Tafuri S, Turoli D, et al. Conventional fascial technique versus mesh repair for advanced pelvic organ prolapse: Analysis of recurrences in treated and untreated compartments. J Obstet Gynaecol 2016;36:410-5.  
    11.Pellegrino A, Damiani GR, Fachechi G, Corso S, Pirovano C, Trio C, et al. Cost analysis of minimally invasive hysterectomy versus open approach performed by a single surgeon in an Italian center. J Robot Surg 2017;11:115-21.  
    12.Gupta N, Miranda Blevins DO, Holcombe J, Furr RS. A comparison of surgical outcomes between single-site robotic, multiport robotic and conventional laparoscopic techniques in performing hysterectomy for benign indications. Gynecol Minim Invasive Ther 2020;9:59-63.  
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