Single Port Robotic Assisted Sacrocolpopexy Using Retroperitoneal Tunneling Technique.

Abstract

Study objective: To demonstrate the feasibility of performing single-port robotic assisted sacrocolpopexy.

Design: Step-by-step description of the surgical procedure using a narrated video.

Setting: Sacrocolpopexy is considered the gold standard for the apical prolapse. However, traditional laparotomic and laparoscopic approaches have limitations, including prolonged operation time, limited visualization, high morbidity, steep learning curve and poor ergonomics with difficulties in repeated suturing using rigid, straight laparoscopic instruments. The single-port robotic platform requires only a single incision measuring 2.5 to 3.5cm, and has started to be used in sacrocolpopexy providing several advantages as shown in the following video (1). Its articulating instruments and camera facilitate the procedure by providing optimal visualization and working space, even in challenging surgical fields, while minimizing collisions within a narrow 2.5cm trocar (2-4). The operation in this video was performed at a tertiary teaching hospital and demonstrates technical feasibility showing how the articulating instruments and camera facilitate the procedure.

Interventions: This video demonstrates a single-port robotic sacrocolpopexy using the da Vinci SP® system. The procedure was performed on a 74-year-old patient with stage 4 apical prolapse. Several advantages are appreciated. Collaborative handling of three working arms through a single 2.5 cm incision and trocar is unique to this robotic platform. Intracorporeal suturing and retroperitoneal tunneling is facilitated by the articulating instruments (3,5). Enhanced visualization of narrow spaces is noted using the articulating camera. Surgeon controlled suction and irrigation tube is used, eliminating the need for an additional port.

Conclusion: Single-port robotic assisted sacrocolpopexy is a feasible and novel option for treating apical prolapse.