Figure - available from: Journal of Robotic Surgery
This content is subject to copyright. Terms and conditions apply.
Anatomy below the arcuate line and location of the spiral technique sutures during robotic-assisted laparoscopic apical suspension. a Cross section below the arcuate line, b anterior apical suspension. Blue arrow: suture behind peritoneum. White arrow: Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon) to keep suture tension, c computed tomography of the pelvis, 4 cm above the pubic symphysis. 4 cm lateral to the midline, placement of the spiral sutures, d diagram of spiral sutures location, identification of the inferior epigastric
Source publication
This video’s objective was to describe our spiral technique and surgical steps of robotic-assisted laparoscopic apical suspension (RALAS) in the treatment of patients with symptomatic apical vaginal prolapse. A 70-year-old Caucasian woman, gravida 3, para 2 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound...
Similar publications
Background
We report on childbirth trauma resulting in a rare stretching and prolapsing of the anterior lip of the cervix beyond the vaginal introitus, and describe the management.
Case Presentation
A 17-year-old primigravida who had normal antenatal care delivered a live normal male baby weighing 3600 g at 39 weeks of gestation. The patient susta...
Citations
... Clinically, however, it can be identified both abdominally, and vaginally. As we have previously demonstrated in our description of the PF reconstruction technique, [4][5][6] repair of the PF is essential during robotic sacrocolpopexy. Therefore, we believe that identifying PF defects is critical in the evaluation of patients with anterior and apical pelvic organ prolapse (POP). ...
... PF reconstruction during robotic sacrocolpopexy was performed as we have described previously. [4][5][6] Concomitant anti−incontinence surgery with trans-obturator tape (Obtryx II, Boston Scientific) was performed during the u-RALS-PFR procedure in 2 patients. Hysterectomy was necessary for 9 patients (45%) and was performed as laparoscopic or robotic-assisted supracervical hysterectomy. ...
... We recently published our technique of PF reconstruction during robotic sacrocervicopexy. [4][5][6] We found that 7% of our patients in whom PF plication was not performed had anterior compartment failure within 6 months'. We found that by performing PF plications, we could potentially improve anatomic and surgical outcomes of the anterior compartment. ...
Objectives
To evaluate the pubocervical fascia (PF) in patients with pelvic organ prolapse (POP) using 3-dimensonal endovaginal ultrasonography (EVUS) and to correlate the PF appearance with both pelvic examination and intraoperative findings during ultrasonographic robotic-assisted laparoscopic sacrocervicopexy and pubocervical fascia reconstruction (u-RALS-PFR).
Methods
A retrospective analysis was performed in 120 women with symptomatic POP. Preoperative evaluation was done using EVUS. We identified areas of PF weakness based on pelvic examination as hypoechoic and hyperechoic defects (HHD) between the bladder and vagina. Study measurements included distance from the HHD to the pubic symphysis, HHD to the bladder neck, HHD to the posterior bladder wall, and hypoechoic-hyperechoic area. We correlated these metrics with the respective POP-Q stages and findings during u-RALS-PFR.
Results
Using the quantitative measures during EVUS, we found a significant association between mean HHD (2.7 cm) and POP-Q stage 3, and between HHD and number of plications performed during surgery. The larger the HHD, the more severe the POP-Q stage of the anterior compartment of the vaginal wall; thus, more plications were performed on the PF (7-12 plications) during robotic sacrocervicopexy, and consequently the anterior arm of the Y-mesh was significantly trimmed (6-8 cm).
Conclusions
HHD obtained by EVUS was associated with severe POP-Q stage 3 and seemed to correlate with the number of plications during robotic sacrocervicopexy. Performing these plications on the PF significantly decreased the length of the anterior vaginal mesh needed for the procedure. These findings may open new applications for preoperative ultrasonography in evaluation and treatment of patients with apical and anterior POP.
... In our previous publications, using mesh-free robotic surgical approaches on our patients, we have seen a recurrence rate of 12% at 12 months [4,11] and 20% at 24 months (unpublished data). The recurrence rate is higher at 5 years as shown in other publications, using a mesh-free approach-45-55% after sacrospinous or uterosacral ligament suspension [10]. ...
The objective of this study was to evaluate our technique of ultrasonography and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) versus standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) in the treatment of patients with symptomatic apical/anterior vaginal prolapse. A retrospective analysis was done
using the data in two community hospitals. Thirty women presented with symptomatic vaginal apical prolapse and desired minimally invasive surgery (video): (a) standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) (n = 15) or (b) ultrasound and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) (n = 15) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative staging. There was longer operating room time in the u-RALS-PFR group compared with the s-RALS group (average difference 35 min); however, sacral promontory dissection time was less in the u-RALS-PFR (average difference of 15 min). The anterior/posterior vaginal dissection and mesh tensioning time was longer in the u-RALS-PFR, as expected. There was only one surgical and anatomic failure (7%) in the s-RALS group after 6 months of surgery (POP Q = Aa + 1, Ba0, Ap-2, Bp-3, C-7). Our technique of ultrasonography and pubocervical fascia reconstruction during RALS appears to be feasible and safe. It aims to improve anterior and apical support, minimize the use of mesh and improve visualization during surgery. u-RALS-PFR approach will add some additional time during surgery but may provide better outcomes.
... 16 Robot-assisted muscle surgery has also been reported for many large muscles, such as latissimus dorsi, diaphragm, Heller, bladder, vagina, and pelvic muscles. [17][18][19] We report here the feasibility of robot-assisted simulated strabismus surgery using the Xi da Vinci Surgical System. All steps including lateral rectus plication, recession, and resection were completed successfully on a strabismus eye model. ...
Purpose:
This study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery.
Methods:
Robot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed.
Results:
Robot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22-35). There were no complications or unexpected intraoperative events.
Conclusions:
Experimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery.
Translational relevance:
Further experimentation will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
Genital prolapse is a widespread condition in women. Sacrocolpopexy has been considered the primary method of treating this condition for many years. With the advent of robotic surgery, sacrocolpopexy has acquired a new life. Despite this, there is still much interest in this procedure, and many questions remain unanswered. This chapter describes in detail the etiology and pathogenesis of genital prolapse and presents the classification of the disease; details of robotic sacrocolpopexy and sacrohysteropexy, in particular, are given. It focuses on the most practical aspects of treatment of POP (pelvic organ prolapse) using recent developments of robotic technologies.
