VCU news

By Malorie Burkett

da Vinci 1: "The da Vinci allows us to do this very complicated procedure laparoscopically."
da Vinci 2: "The operation may be better and safer."

The Virginia Commonwealth University Medical Center is now performing da Vinci sacrocolpopexy – a minimally invasive surgical procedure designed to correct pelvic organ prolapse.

Pelvic organ or uterine prolapse occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvic and vaginal tissues in their natural orientation. More than 120,000 cases of uterine and vaginal vault prolapse are surgically treated each year in the United States.

Prolapse of any pelvic floor organ— vagina, uterus, bladder or rectum, occurs when the connective tissues or muscles weaken with age, after child birth, with weight gain and strenuous physical labor.

Catherine Matthews, M.D., associate professor in the Division of Urogynecology and Reconstructive Pelvic Surgery in the Department of Obstetrics and Gynecology, performs the corrective surgical procedure using a minimally-invasive state-of-the art technology known as the da Vinci robot.

Women suffering from this condition typically experience problems with bulging of the vaginal tissues, pelvic heaviness or pressure, urinary leakage, bowel control and evacuation problems, vaginal irritation and sexual dysfunction. These problems, which women often don't discuss because of personal embarrassment, can have a dramatic negative effect on quality of life, according to Matthews.

"The use of the da Vinci which has the articulating arms and the ability to do extensive meticulous dissection and suturing has really allowed us to make this operation very feasible through a laparoscopic approach," said Matthews.

The gold-standard operation for uterine prolapse traditionally has been an open surgery known as sacrocolpopexy, where mesh is used to suspend the vagina in the correct anatomical position. A horizontal incision between 15 centimeters and 30 centimeters is made in the lower abdomen in order to manually access the inter-abdominal organs, including the uterus.

In the past, the abdominal operation prolonged the hospital stay and the recovery time and increased the pain level for patients.

According to Matthews, however, the introduction of the da Vinci robot technology allows surgeons to perform this complicated operation laparoscopically, with four very small abdominal incisions.

Matthews says that one of the major benefits during the operation is the magnification that the robot provides. When dissecting a dangerous place, the 3-D magnification allows the physician to see much better.

Post-operative benefits of the da Vinci-assisted sacrocolpopexy include a significantly shorter hospital stay, less pain and minimal oral pain medications. Patients also have the ability to return to regular activities, including work, within about two weeks as opposed to six to eight weeks after a standard abdominal incision.

"This really allows people to have an efficient, effective operation from which the recovery is very reasonable," said Matthews. "I think it has really opened the gateway to many more people to be able to physically address something that otherwise they might have been putting off. The cosmetic benefits of tiny laparoscopic incisions as opposed to a major abdominal incision are also notable."