Robotic Assisted Sacrocolpopexy

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This is a surgical procedure used to treat pelvic organ prolapse by using surgical mesh to lift the affected organs and secured to the sacrum.

Indications:

  • Performed for symptomatic pelvic organ prolapse, vault prolapse or uterine prolapse
  • Indicated for high degree of prolapse
  • Symptoms:
    • Pressure feeling in the vagina or bulge visible at the opening of the vagina
    • Difficulty in urinating or passing bowel motions
    • Urinary symptoms consisting of incontinence or frequency
    • Pain with intercourse

Procedure:

  • This is done under a general anaesthetic
  • Abdominal approach using robotic assisted techniques
  • A Y-shaped mesh is attached at the top of the vagina with arms in front and behind, stretched to a strong ligament covering the sacrum
  • May have a concomitant cystocele repair

Recovery:

  • Usually a 2 to 3-day stay in hospital
  • You will have a catheter in the first day
  • Recovery can take up to 6 – 8 weeks
  • Avoid strenuous activity such as lifting heavy objects
  • Success rate is between 85 and 90%
  • Be aware that you would have mesh in place, yet no ruling regarding trance abdominal mesh has been influenced by the FDA and TGA statements

 

Wes RA SacroColpoPexy

Colpocleisis

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Permanent closure of the vagina in the elderly who suffer from pelvic organ prolapse and who aren’t and never will be sexually active.

Why is it done?

  • The aim of surgery is to relieve the symptoms of vaginal bulge and / or laxity.
  • Improve bladder function.
  • Used where women are elderly and have no desire to be sexually active again.
  • Vaginal prolapse is a common condition causing symptoms such as a sensation of dragging or fullness in the vagina, and difficulty emptying the bowel or bladder and back ache.
  • About 1 in 10 women need surgery for prolapse of the uterus or vagina.

 

How is it done?

  • This procedure is done under a spinal / general anesthetic, as decided by the anesthetist.
  • A large portion of the vaginal mucosa is removed on the bladder and rectal side, from the vault to the introitus.
  • The edges of the front wall are sewn to the back wall, therefore occluding the whole urethra.
  • The side of the vagina is not occluded to allow drainage of fluids.
  • A catheter is placed into the bladder at the end of surgery.
  • The catheter is removed the next day

Complications?

There are also general risks associated with surgery:

  • Wound infection.
  • Urinary tract infection.
  • NO MORE VAGINAL INTERCOURSE.
  • Rarely – Bleeding requiring a blood transfusion and Deep vein thrombosis (clots) in the legs, Chest infection.

 

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Wes Colpocleisis

Cystocoele Repair (Natural)

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Repair of an anterior / bladder prolapse using natural tissue and repair of introitis

 

Why is it done?

  • The aim of surgery is to relieve the symptoms of vaginal bulge and / or laxity.
  • Improve bladder function without interfering with sexual function.

How is it done?

  • This procedure is done under a spinal / general anesthetic, as decided by the anesthetist.
  • An incision is made along the center of the front wall of the vagina starting near the vaginal entrance and finishing near the top of the vagina.
  • The vaginal skin is then separated from the underlying supportive fascial layer.
  • The weakened fascia is then repaired using absorbable stitches, which will absorb over 4 weeks to 5 months depending on the type of stitch (suture) material used.
  • Sometimes excessive vaginal skin is removed, and the vaginal skin is closed with absorbable sutures, these usually take 4 to 6 weeks to fully absorb.
  • Reinforcement material in the form of biological (absorbable) may be used to repair the anterior vaginal wall.
  • Mesh is no longer used
  • A cystoscopy may be performed to confirm that the appearance inside the bladder is normal and that no injury to the bladder or ureters has occurred during surgery.
  • A pack may be placed into the vagina and a catheter into the bladder at the end of surgery.
  • If so, this is usually removed after 3-48 hours. The pack acts like a compression bandage to reduce vaginal bleeding and bruising after surgery.
  • You will have a vaginal pack to reduce any bleeding.
  • Both the pack and the catheter are usually removed within 48 hours of the operation.

How successful is the surgery?

  • Quoted success rates for anterior vaginal wall repair are 70-90%.
  • There is a chance that the prolapse may come back in the future, or another part of the vagina may prolapse for which you need further surgery.
  • Recurrence rates are as much as 50% in the next 3 years.

No Intercourse for 6 weeks following surgery!

Complications?

  • With any surgery there is always a small risk of complications.
  • Anesthetic problems. With modern anesthetics and monitoring equipment, complications due to anesthesia are very rare.
  • Bleeding. Serious bleeding requiring blood transfusion is unusual following vaginal surgery (less than 1%).
  • Post operative infection. Although antibiotics are often given just before surgery and all attempts are made to keep surgery sterile, there is a small chance of developing an infection in the vagina or pelvis.
  • Bladder infections (cystitis) occur in about 6% of women after surgery and are more common if a catheter has been used. Symptoms include burning or stinging when passing urine, urinary frequency and sometimes blood in the urine. Cystitis is usually easily treated by a course of antibiotics.
  • Constipation is a common postoperative problem.
  • Pain with intercourse (dyspareunia). Some women develop pain or discomfort with intercourse.
  • Damage to the bladder or ureters during surgery is an uncommon complication which can be repaired during surgery.
  • Incontinence. After a large anterior vaginal wall repair some women develop stress urinary incontinence due to the unkinking of the urethra.
  • This is usually simply resolved by placing a supportive sling under the urethra section.

 

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Wes Cystoscoele Repair Natural