Sacrocolpopexy (patient version): Here’s what to expect during the robotic procedure

Hi, I’m Dr. Rich. And my passion is to provide every woman with practical knowledge about the world of women’s health.

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Today, we pick up where we left off on the topic of sacrocolpopexy. What is it? You probably wouldn’t know unless your doctor told you needed one today, we’re back again with Dr. Erin Meyers. So we mentioned a couple of times, uh, robotic and robotic surgery. Um, so if you would take a minute and just kind of explain what’s the advantage of robotics, as opposed to doing like an open incision, a C-section, or maybe even an up and down incision? 

Dr. Erin Meyers (00:46):

Well, for one thing with robotic surgery, my patients are able to go home the same day. Uh, if you have an open incision, typically that requires it two or three nights stay in the hospital. So a robotic surgery gets you home faster with your family. There’s less pain and you’re going to heal faster. And so I think for all those reasons, it’s amazing, uh, from a patient perspective, but from a surgeon perspective, the robot does have a 3d camera magnifies things. And it allows me to feel actually like I’m inside the abdomen, almost like a virtual reality. I’m in there performing the surgery and everything that the robotic hands do. I’m actually doing outside of the body with my own hands. And so I don’t have to traumatize my patient by putting my big hands inside her belly. I can put tiny little robotic instruments inside and do meticulous surgery. And, um, with that offer her, I don’t know, a very elegant procedure. 

Dr. Rich (01:48):

That’s a, I think that’s a very great description. Um, there’s one other question that frequently comes up and to the patient, they, they just, they just know that there’s a bulge, it’s uncomfortable. Um, we talked about the different, uh, organs that can be behind the vaginal skin that’s prolapsing. And yet many patients will be confused because they’ll feel terms like bladder lift or bladder sling or this new term sacred colpopexy could be the same thing. Are they the same? Or are they different? 

Dr. Erin Meyers (02:25):

So Rick, so many of these terms are just confusing for me. So just to lay it out there, the patients are not the only ones confused. So for me, when I hear that one of my patients has had a bladder tack in the past, like go through their surgical history. What surgeries have you had to me? That’s not very helpful. This term means so many different things for me. It’s the same thing as saying, I’d drive a car. Well, is it two-door? Is it four-door? Is it white? Is it red? Is it black? I don’t know. So, um, you know, I think when someone says they have a bladder tack, we really need to get the operative notes to kind of understand what that means. And many women can have surgery in the pelvic area that could be a hysterectomy. It could be an incontinence surgery. 

Dr. Erin Meyers (03:10):

It could be an, a PZ otomy type procedure on the anal area, or it could be a prolapse surgery. So there’s so many different things. And I think a bladder Tactus, isn’t specific enough to understand really what’s going on. Uh, for your question specifically, colpopexy is more of a prolapse surgery and it really is the best prolapse surgery that we have available. Uh, it does not treat leakage. So if a patient does have leakage of, of your entering incontinence, um, uh, Coldwell Pepsi is not going to address that, but it is very good at addressing prolapse. And that is that a loss of support or tissue where the vaginal tissues falling down. 

Dr. Rich (03:50):

And so some patients will also have an incontinence sling at the time of a sacrocolpopexy, um, or they may not have one. And after the suspension, they may start leaking urine. Is that normal? Is that expected? Uh, why, why do we do slings at the time of the sacred call taxi? 

Dr. Erin Meyers (04:13):

Yeah, that can be a very confusing point for patients to understand. And so when the prolapse is out or down or at its worst, it’s frustrating cause it’s causes both symptoms, but it might be nice because, because the bulge blocks leakage essentially. And so when we surgically reduced the bolt or we put things back where they need to be, it’s easier to urinate. Like we said, maybe less urinary tract infections, but it’s also easier to leak. So depending on a patient’s presentation, we may or may not recommend a sling at the time of surgery. And a sling is different than a Coldwell Pepsi in that a sling supports the urethra and that’s the outlet of the bladder. So a patient won’t leak. 

Dr. Rich (04:58):

I find it sometimes helpful just to describe to the patient, you know, simply by showing my, my hand and, and then the finger, the hand is the bladder, the fingers urethra, when, when the bladder is down, you can see the urethra is kinked and the urine might not be able to make it around that kink. And when we lift up the bladder and restore that normal anatomy, we remove that obstruction. And so in a way we’re actually unmasking incontinence that existed, but they didn’t have symptoms because of the obstruction. 

Dr. Erin Meyers (05:34):

I absolutely agree. I love to use hand puppets in my clinical counseling as well, but I absolutely agree they had it all along, but they didn’t know they had it because the prolapse was blocking it and in just fixing the prolapse that can unmask what they already had. And, uh, and luckily we do have slings available and we can address their leakage with that. 

Dr. Rich (05:58):

That’s great. And the, I guess I would say one of the final questions would be we’ve called this procedure, the gold standard. Um, is it infallible? Is this a surgery that, um, is good for life? Uh, is it possible for a recurrence? Is it possible for them to get a prolapse again? And if it does happen again, is that necessarily a bad technique or a bad surgery or is that just statistics? 

Dr. Erin Meyers (06:29):

Gosh, that’s a hard question. So this is the best surgery that we have for long-term success. Recurrences can happen though. Unfortunately, risk factors for that are going to be possibly recurrent, heavy, heavy lifting, chronic constipation, or maybe even a weight gain to the area. And so a recurrence we have to be careful is the whole vagina, or is the prolapse all back or is it a little area? Sometimes ladies will notice a rectocele what that is, is the back wall of the vagina can prolapse out around the mesh. So the colpopexy still working, but they feel a bulge and don’t understand why we can do an exam and see, Oh no, this is a rectocele, it’s something different and we can fix with stitches and not mesh. Uh, and so that would be a different situation entirely rarely. Um, I I’d say less than one, every three years, would I see where the mesh just broke, um, or, you know, slipped off of the sacrum or came detached and they just needed that fixed. So there are, you know, rare things that can happen in that way. Um, but you know, we just figure out what’s going on by doing an exam and then, you know, address it together with the patient. 

Dr. Rich (07:41):

So if you were going to say to a patient, um, somebody that might be watching this video and they want to know what level of expertise should they look for for this type of surgery. Um, does it make a difference if it’s a urogynecologist or an OB GYN, or is it really just about the surgical volume? 

Dr. Erin Meyers (08:04):

Uh, you know, I think that’s a really tough question. It probably depends on the region location and other things where the patient, uh, really resides. And I would say it’s the volume. And so if, if a surgeon feels comfortable and is doing many of these surgeries, for example, I do four to six of them a week. You know, I think that you’re gonna make your patient feel safe, and you’re going to understand the complications and be able to handle complex procedures versus, you know, if you ask your surgeon and they say they do one or two a year, you know, that may not be a safe of an option. Uh, so regardless of the training, I think he wants somebody who, who really focuses on this area and is the majority of their practice. 

Dr. Rich (08:47):

So some patient may ask if their physician told them that they’re going to do a backseat, but they needed to have an open incision. Um, what are your thoughts around that as opposed to robotics? 

Dr. Erin Meyers (09:04):

Well, Rick, I’d say that maybe two or three times a year with my hernia colleagues, I will do an open colpopexy we’ll perform maybe a [inaudible] me. Maybe they need a large hernia repair and we’ll make a big incision, um, that the patient needs. And while we’re there, we’ll also do the Coldwell Pepsi. And for me, I think that’s really the only reason that a patient should have a big incision. Otherwise they really should have a minimally invasive approach that offers them the ability to go home the same day, have less pain and faster healing. 

Dr. Rich (09:38):

And so anybody that might be finding themselves in that situation, uh, perhaps a second opinion. Um, and if I understand you correctly, in most circumstances, and in most markets, there probably is an expert who will offer a minimally invasive option. 

Dr. Erin Meyers (09:56):

That’s what I find. Yes. 

Dr. Rich (09:58):

So most of my practices are robotic surgery practice. Um, we still do a fair amount of vaginal work, but I rarely ever do an open incision. And usually for the indications that, that you’re describing, what can misconceptions are there around robotics? What, uh, questions have patients had for you, um, with [inaudible] or any robotic surgery? 

Dr. Erin Meyers (10:23):

Uh, that’s a great question. And, uh, some of the time I’ll actually pull up a picture of what the robot looks like, so they feel safe. Uh, but, uh, essentially some patients will ask me, am I doing the surgery or is the robot doing the surgery? And thankfully I still have a job and there’s no program that I can just hit enter. And the Coldwell flex seal will be done. So for me, the, um, the robot is a tool that I use and the arms of the robot go through tiny incisions in the patient’s belly or abdomen. And then I get to control those instruments using a console outside the body. So I’m almost sitting at a video game console and whatever my hands do outside in that console, teeny tiny robotic instruments do inside the patient. So for now I still get to operate. 

Dr. Rich (11:13):

So, so video game constantly, you just inspired a whole generation of robotics, I think with that. Um, yeah, I find that the patients, uh, have some concern. I know we have information on the website, but I hadn’t thought about showing them a picture of the robot. I think that’s, uh, that’s probably, uh, would be helpful and maybe calm, calm their concerns about that. Well, this is fantastic information. I certainly appreciate you taking the time to help us, uh, provide meaningful, useful educational material, um, as always is not specific medical advice to any individual and you should always consult your doctor, but thank you again so much for joining us and we’ll look forward to having you on the channel again.

Dr. Erin Meyers:

Thank you so much for having me appreciate it. 

Dr. Rich (12:08):

And now, you know, everything there is to know about sacrocolpopexy, but if you still have questions, drop them in the comment section below and we’ll help you out. And as always, please remember to subscribe.