120,000+ cases of uterine and vaginal vault prolapse are surgically treated each year in the U.S. Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder or rectum) occurs when the connective tissues or muscles of the pelvic floor are weak and unable to hold the pelvic contents in their natural orientation.
The weakening of pelvic floor connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapse typically have problems with urinary incontinence, bulging of vaginal tissue outside the vaginal opening, difficulty with bowel movements, or sexual dysfunction. The various terms that are used to describe prolapse include:
During your evaluation you will be specifically examined for anterior, posterior or apical (uterus, vaginal cuff) prolapse of the vaginal walls.
The Treatment: Sacrocolpopexy or Sacrocolpocervicopexy
Sacrocolpopexy: If the uterus has already been removed with a previous hysterectomy and the condition is vaginal vault prolapse then sacrocolpopexy is a procedure to surgically correct the prolapsing vaginal walls. Two mesh straps are sutured to the anterior and then posterior vaginal walls and the other ends are sutured to a ligament on the sacrum (lower spine). This holds the vagina in the correct anatomical positionand this procedure is considered to be the most durable and anatomically normal of all the operations for apical or vaginal vault prolapse.
- Sacrocolpocervicopexy: If there is uterine prolapse, we typically recommend removing the fundus (the upper bleeding portion) of the uterus and leaving the cervix attached to the vagina (supracervical hysterectomy). The anterior and posterior mesh are then attached to both the vagina and the cervix and then the sacrum. This procedure is called a sacrocolpocervicopexy.
In either of these procedures no cutting or entry into the vagina is done so that the vagina maintains its full length.
Sacrocolpopexy and sacrocolpocervicopexy have traditionally been performed as an open surgery,. during which a five- to six-inch incision is made in the lower abdomen in order to manually access the intra-abdominal organs, including the uterus. This open procedure typically requires a two or three day hospitalization and a four to six week recovery.
The da Vinci Alternative
If your doctor recommends sacrocolpopexy or sacrocolpocervicopexy, you may be a candidate for a new surgical procedure called the da Vinci robotic-assisted laparoscopic sacrocolpopexy or sacrocolpocervicopexy (RALSC) . This procedure uses a da Vinci state-of-the-art surgical system designed to help your surgeon perform a minimally invasive laparoscopic surgery through 5 small incisions.
For most women, the da Vinci RALSC offers numerous potential benefits over a traditional open approach:
- Significantly less pain and less of a need for pain medications
- Less blood loss and need for transfusions
- Less risk of infection
- Less scarring – 5 small <½ inch incisions instead of a large 5-6 inch incision
- Shorter hospital stay – typically the hospital stay is only overnight
- Shorter recovery time
- Less time off work
- Quicker return to normal activities
Drs. Nager and Lukacz have performed more than 50 of these procedures in the last 2 years with good results. If you are interested in learning more or to determine if you may be a candidate for this procedure, please make an appointment in the UCSD Women’s Pelvic Medicine Center by calling 858-657-8737.
Learn more
Read a sample consultation between a UCSD surgeon and a patient considernig robotic surgery
Watch a 52-minute presentation on the Advantage of Robotic Surgery
Mark Talamini MD, discusses the advantages of these new technologies and how they are best applied.