Dr. Rich (00:00):
If you’re a surgeon looking to get into Sacrocolpopexy or an experienced provider, just looking to up your sacred game, don’t go any further. My colleague and I will go over an in-depth expert approach to all the tips and tricks you need to perfect your cyclical plexi game.
Don’t have time to read this blog post? Watch it here instead!
Dr. Rich (00:24):
Hi, I’m Dr. Rich and my passion is to provide every medical provider with up-to-date knowledge about the world of women’s health. For doctors, surgeons, medical providers. Today, my expert colleague is going to join us via zoom to discuss in depth the Sacrocolpopexy procedure. So get out your notepads. Let’s go. So thank you for coming back. We have, uh, our esteem colleague, Dr. Aaron Meyers from Charlotte, North Carolina, joining us from atrium health. She’s a urogynecologist and the director of her, uh, research program for her urogynecology fellowship. Um, I’ve worked with Erin for years and we’ve done a number of presentations and it’s always a pleasure. Thanks for joining us.
Dr. Meyers (01:13):
Thank you so much for having me. I enjoy working with you as well.
Dr. Rich (01:18):
What I’d like to talk about today is the Sigrid cobalt, Mexi procedure, specifically robotics, and how we can, um, for those doctors that are looking for incorporating this to be a larger portion of their practice, um, maybe they’re doing a lot of vaginal prolapse work and they didn’t get as much training. What does that transition look like? How do we incorporate the sacred into our practice and be successful or surgeons that find themselves doing high, high volumes of robotic surgery? Not necessarily, um, this type of prolapse work, where do they start? How, what is the formula for success?
Dr. Meyers (02:02):
Gosh, Rick, I think that’s a really hard question because you have, uh, physicians or surgeons of different backgrounds and they’re going to probably need a different recipe. So, uh, you know, all in all, you probably just need to jump in and do it depending on what your method might be. If you are a vaginal surgeon predominantly, you may need to go to a training course, you may need to do some robotics simulation, get proficient with the robot itself. Uh, when I teach, I tell my learners are robot. Um, simulation is kind of like learning to drive a manual transmission. Unfortunately, most of my learners are so young. They don’t know what that means. Um, but if you learn how to change the gears and, and shift as you drive, you can learn that, but you’re not learning where to drive or where to go. And so the simulator really helps you learn the robot, and then once you learn the robot, you can use that as a tool, be potentially the best surgeon you can be.
Dr. Meyers (03:02):
Um, and so maybe the, the surgeons who are really proficient vaginally would want to start with a simple hysterectomy, um, you know, someone with no surgical history, a small uterus, and, you know, really try to start off with, with easy things that can build their confidence and help them, you know, really with their repertoire, uh, to become a better surgeon. And, you know, maybe some courses, maybe, um, some online courses, maybe some in-person courses or proctoring or mentorship. Uh, everyone does learn a little bit differently. Uh, for me, I did, uh, go to a fellowship to learn, uh, robotics and pelvic surgery. Um, but learning that outside of a fellowship might be much more challenging. Uh, you may have to juggle your current practice, some family obligations, and so on. So it really might be challenging in order to, uh, have someone observe you or you traveled to observe somebody else. Uh, so I think it would be quite a commitment, uh, to be able to take on this extra skill set, I guess, is what I’m trying to say.
Dr. Rich (04:03):
So if I can, you know, perhaps summarize in a sense, um, you want to make sure you’re doing this surgery on the right patients, um, simple cases for cyclical first, or if you’re just getting used to the robot platform, um, simple maybe hysterectomy or other cases, but essentially build up the skillset on the robot, um, or with Sacrocolpopexy with less challenging cases. And, uh, probably a second one, as you said, you just got to do, it would be a volume and at least on the courses that you and I have taught together, um, it seems to be somewhere around 50 a year, which frankly is probably still a little bit of a low benchmark, I think because that’s maybe one a week. Um, and then the last thing is resources. So there are plenty of resources out there. There are, uh, online forums. Um, there are video libraries. There are, you know, with the different societies. Um, there are industry-sponsored events and then of course society sponsored events.
Dr. Meyers (05:18):
I completely agree with your synopsis there and, you know, watching other people’s videos, uh, and watching your own videos is relatively simple. You don’t have to pay for a course or anything to do that. Uh, but then traveling to actually, you know, learn from some experts or have some mentorship along the side would also be helpful. I think if you’re trying to pick up any new skill, um, you know, throughout your career.
Dr. Rich (05:43):
And one of the methods that I often suggest to course participants artists start with a, um, it seems more difficult to do a sacred hysterectomy. Um, but in actuality, it’s, it’s oftentimes easier because in a post-hysterectomy sacred where they’ve already had hysterectomy, you’re only doing the sacred pole backseat by definition, they’ve all had pelvic surgery. They’ve all had that Becka vaginal plane disrupted in the past. And it actually can end up being more challenging than doing the hysterectomy, having all the planes preserved and then either a total or a super cervical hysterectomy, and then just placing the mesh in those planes. Um, I found that when I’m proctoring or when I’m doing courses and I’ve made that suggestion, um, it may at the beginning take a little bit longer, but ultimately I think easier for them to get the basic skillset down and get the actual time of the procedure down so that they can start doing some of the more challenging cases.
Dr. Meyers (06:56):
I could not agree with you more. And I really do think traditionally, or maybe historically vaginal procedure has been, you know, touted as you know, what we do first, or that’s the algorithm of when someone has prolapse you do a vaginal procedure first, when, or if that recurs, then you offer a Coldwell Pepsi next. Well, I think that’s because you had to do an abdominal incision to perform a Coldwell plexi. Now that we have minimally invasive options, you can do the Coldwell Pepsi first. And I do agree with you that makes it so much easier. You don’t have distorted or scarred tissue planes. easily dissect through the bladder flap or create the vested vaginal septum. You can do the rector vaginal septum dissection really quite easily and quickly, and that can build your confidence so that you can handle the post hysterectomy, prolapse patients, maybe later on
Dr. Rich (07:59):
Some of the challenges that can arise during the cerebral Bexley procedure. I think most often, um, surgeons that are learning the procedure are intimidated by the, uh, pre sacral space. And with good reason, you know, we’ve got the left comment like vein, um, middle cycle vessels are nothing to trifle with. Um, but frankly the most difficult part I find the cyclical backseat is the bladder plane is the vessel of vaginal space because the rectal vaginal space nobody’s had surgery there before. That’s always preserved the presurgical space virtually nobody’s had surgery there, uh, even the right pelvic sidewall Parexel’s space. Um, oftentimes the, the biggest challenge is to get into the Vesco vaginal space and develop it. What are some of the, uh, tools or, um, I pearls or tricks that you would use perhaps in a difficult or a more, uh, a bladder plane that has a lot of scarring.
Dr. Meyers (09:04):
I couldn’t agree with you more, the rectal vaginal space and sacred. We usually follow the rules. And so you can go pretty quickly in there. The Vestigo vaginal space could be a gamble as to what you’re going to get. And a couple of things I’ll do on challenging cases is I will either ask my assistant to insert the fully more. And so the Foley balloon will actually kind of flip on itself and the actual, I guess, rest of the Foley strip will come up and it will actually just outline where the bladder edge is. So that’s super fast. You don’t have to wait for the bladder to be filled or anything like that. So that’s the first thing I’ll do. And, you know, you can always retrograde fill the bladder. If you want to, you know, if you’re really nervous, you can perform cystoscopy and actually see where that edge is.
Dr. Meyers (09:54):
Sometimes in the operating room, you can have a robotic camera and assist a scopic camera. So you can see the light can, you know, eliminate exactly where that border is. That may be overkill for most cases. Um, but I kinda think a fast way to do that is to just push the fully in further and, and the rest of the fully, um, I dunno, what do you call the rest of that after the balloon, but the rest of the fully comes in and just curves around nicely for the bladder. And you’re able to see exactly where the margin is, no guesswork involved.
Dr. Rich (10:24):
If you found this video helpful, we have more videos on the topic of cyclical, bull Pepsi coming. So please remember to hit subscribe and like.