The Women's Journal

Pelvic Organ Prolapse – Better Care Through Robotics

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By: Dr. Howard Goldstein, Dr. Babak Vakili and Dr. Emily Saks

Pelvic organ prolapse is a condition where the structures in the pelvis – the vagina, uterus and/or bladder – drop from their normal position. These organs can sag into the vagina and can even protrude through the opening of the vagina. Although prolapse is not life-threatening or dangerous, prolapse is often mistaken for a tumor and can be quite troubling.

Prolapse occurs when the ligaments and the muscles of the pelvis give way. To correct the problem, the support needs to be restored. The only non-surgical way to do this is using a pessary. Pessaries are devices that are placed in the vagina, similar to a tampon or diaphragm. They come in a variety of shapes and sizes that are selected based upon your individual anatomy. Pessaries resolve the symptoms of the bulge without surgery and can be used temporarily or long-term. Unfortunately, pessaries do not correct the damage – they just brace it.

The good news is that prolapse can be corrected surgically. Surgery for prolapse serves two purposes. The first is to restore the organs to their normal position. The second is to ensure those organs function normally. It makes no sense to fix a prolapse and have urinary, bowel or sexual dysfunction.

At the Christiana Care Center for Urogynecology and Pelvic Surgery we offer vaginal, abdominal and robotic surgery to correct pelvic organ prolapse. Depending on the type of prolapse, one or more options may be available to you.

Robotic surgery via the da Vinci Surgical System was first released in the United States in 1999.  Its first application was for the treatment of prostate cancer. In April 2005, the FDA approved this technology for use for pelvic organ prolapse. Over the last five years this technology has been adopted by many urogynecology centers throughout the United States including the Christiana Care Center for Urogynecology and Pelvic Surgery. All three surgeons offer this option for suitable patients in need of an abdominal prolapse repair.

The da Vinci Surgical System technology provides many advantages over the traditional abdominal approach. Traditional surgery for prolapse is performed through a large abdominal incision, also called a bikini cut. This approach can lead to post operative pain with a typical return to normal function occurring at approximately six to eight weeks.  Patients typically stay in the hospital three to four days.

After going through the robotic approach, patients are often in very little pain. Four to five hours after robotic surgery, patients are typically eating dinner and walking around their hospital floor. Patients feel so good that they usually leave the hospital only after one night and return to normal function within three weeks. Research has shown that robotic surgery leads to less blood loss and lower rates of infection. This technology has revolutionized the treatment of pelvic organ prolapse and has expanded minimally invasive surgery to the abdominal approach.

In some circumstances, the best way to surgically correct prolapse is through a vaginal approach. This approach leaves all of the scars within the vagina. Vaginal surgery for prolapse has existed for over 100 years; however, only since 1996 with the advent of vaginal mesh has this approach been radically altered.

Prior to mesh, vaginal repair of prolapse was successful approximately 50 percent of the time. Now, success rates reach 95 percent or better. Vaginal mesh repairs can provide a minimally invasive approach to prolapse repair that allows return to normal activity within three to four weeks and long lasting success.

The decision to use mesh in the vagina should be made with great consideration.  Although a successful option, there are potential complications that although correctable can prolong the recovery phase. The physicians at the Christiana Care Center for Urogynecology and Pelvic Surgery will review all of your surgical options with the benefits and potential complications for each approach. This will assist you in making the best decision for your type of prolapse.

Babak Vakili, M.D. is the director of the Center for Urogynecology and Pelvic Surgery. Dr. Vakili is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at the Louisiana State University Health Science Center in New Orleans, LA.

Howard B. Goldstein, D.O., MPH, is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cooper University Hospital in Camden, N.J.  He currently serves as the Director of Research and Education for the Division of Urogynecology.

The Christiana Care Center for Urogynecology and Pelvic Surgery is located in Suite 1208 of Medical Arts Pavilion 2, on the campus of Christiana Hospital in Newark. Appointments are also available at the Christiana Care Center for Women’s Health, 3706 Kennett Pike in Greenville. To schedule an appontment, call 302-623-4055.

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