Patient Education & Consent
Patient Instructions
One to two weeks before the procedure, the patient must complete a preoperative assessment with a physician, or the nursing staff, to make sure they are able to tolerate anesthesia and that they are in optimal health for surgery. Blood may be drawn, as well as urine collected, for evaluation. An EKG, which is a recording of the heart’s electrical activity, or a chest radiography might also be performed.
The patient will need to shave the pubic hairs along the bikini line before coming in to the hospital the day of your procedure. If the patient does not remember to do so, a nurse will be available to assist.
The patient should not have any food or water 6-8 hours before the procedure. The patient may be asked to have nothing to eat or drink after midnight the night before.
Elements of Informed Consent
A sacrocolpopexy is a procedure to treat vaginal vault prolapse, in which the upper part of the vagina slips downward. This might occur in women who have had children by vaginal delivery or in those who have had a hysterectomy. The procedure is designed to return the vagina to its natural position and function by lifting the vagina back up to its natural position by attaching a synthetic mesh from the top and back of the vagina to one of the bones at the back of the pelvis (sacrum bone).
The procedure can be performed through an open incision, or through a less invasive laparoscopic (with or without use of robotic assistance) incision through the abdomen. During the laparoscopic approach, with or without robotic-assisted assistance, a small needle is inserted through the belly button and gas is gently blown into the abdomen. The gas slowly expands the abdomen for clear visualization of the vagina and other pelvic organs. A small camera (laparoscope) is then inserted through the belly button, and 2 or 3 more tiny cuts are made low down in the abdomen to perform the operation. The cuts may need to be sewn up, which is often unnecessary since the cuts are often so small.
The procedure requires general anesthesia, which means the patient will be asleep during the procedure. The procedure usually takes 2-4 hours.
The patient will have an IV in his or her arm, which will provide the patient with fluids until they are able to drink normally after the procedure. A Foley catheter may be inserted into the bladder through the urethra to help the bladder drain during the procedure, and it may be kept in place for a few days afterwards; there may be difficulty with urination after the procedure. A small drain may be placed in the wound to remove the excess blood and/or fluid if necessary.
The patient will be asked to sign a consent form, which will give permission to perform the operation. Risk and benefits of the robotic-assisted laparoscopic procedure will also be reviewed. Risks include bleeding, infection, damage to nearby organs, ie. the bladder or bowel, failure of the procedure to reach its goal, erosion of the mesh through the vaginal mucosa or bladder, formation of prolapse in another part of the vagina, formation of blood clots in the veins, worsening bladder control, slow return of bladder or bowel function.
Pre-Procedure Planning
Equipment
See the list below:
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2- 12 mm trocars
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2- 8 mm robotic trocars
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Pair of robotic scissors
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Pair of robotic graspers (ie. Maryland, Prograsp, or Blunt)
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Robotic needle drivers
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2-0 Vicryl sutures (ie. Polyglactin)
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2-0 permanent sutures (ie, Novafil)
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Meshed polypropylene Y-graft
Patient Preparation
Anesthesia
The anesthesiologist will discuss risks of general endotracheal anesthesia, which is required for robotic-assisted laparoscopic sacrocolpopexy, given the requirements of pneumoperitoneum and steep Trendelenburg positioning; the anesthesiologist will also answer patient questions.
Positioning
The patient is placed in a modified, low dorsal lithotomy position, with her arms tucked and padded at the patient’s sides. Well-padded stirrups should be used to secure both legs and allow for adequate exposure to the abdomen and vagina. Shoulder pads can keep the patient from sliding on the table. Once the patient is secured from slipping, she should be placed in a very steep Trendelenburg position for preparation and sterile draping (see the image below).
Monitoring & Follow-up
The patient should be discharged with the appropriate set of postoperative care instructions, especially limitations to activity. Any strenuous activity or heavy lifting greater than 10 lbs should be avoided in the first 6-8 weeks after surgery so as not to disrupt the healing process. Bicycle riding and other activities that cause perineal strain or trauma should be disallowed. Sexual intercourse and the use of tampons or applicators into the vagina should also be avoided during healing. Follow-up appointments with a physician should be scheduled at approximately 2 weeks, 4 weeks, 6 months, and 1 year after the sacrocolpopexy procedure.
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Patient positioning
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da Vinci Robotic Instruments
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da Vinci Robotic System
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Diagram of the surgical mesh repair
