Robotic Tips and Tricks for Apical Prolapse Repair-Robotic Tips and Tricks for Apical Prolapse Repair

Video Transcription

Video Summary

The presentation discusses advanced techniques for robotic sacral colpopexy in pelvic organ prolapse repair through three patient cases. Key points include careful abdominal entry to avoid injury, precise preparation of the sacral promontory using retrorectal dissection to minimize bleeding risks, and cautious vaginal dissection to prevent cystotomy or vaginotomy which could lead to mesh exposure. Mesh attachment involves secure but safe suturing—avoiding sacral disc penetration to prevent discitis—with evidence showing no outcome difference between Gore-Tex and PDS sutures. The choice of mesh type matters; lightweight but not ultra-lightweight mesh is preferred for durability. Total hysterectomy raises mesh exposure risk but lowers anterior compartment failure compared to supracervical hysterectomy. Vaginal hysterectomy combined with abdominal mesh provides tailored repair with better outcomes. Addressing the ballooning anterior vaginal wall through repair of pubocervical fascia is crucial to reduce prolapse recurrence. Dividing sacral colpopexy into five steps improves safety and efficiency for optimal, individualized patient outcomes.

Asset Caption

Dr. Catherine Matthews is a Professor of Urology and Gynecology at Wake Forest Baptist Health and serves as the URPS Fellowship Director and Director of the Female Pelvic Health Center.

Keywords

Catherine Matthews

Robotic Tips and Tricks

Tips and Tricks

Robotic

Prolapse

Apical Prolapse

Prolapse Repair

Surgical Video

robotic sacral colpopexy

pelvic organ prolapse repair

retrorectal dissection

mesh attachment techniques

hysterectomy impact

pubocervical fascia repair