2008 Annual Meeting Abstracts
Innovative Technique For Mesh Stablization To The Perineal Body For Robotic Pelvic Floor Reconstruction With Mesh Placement
Sophia Drinis, Daniel Rukstalis
Geisinger Medical Center, Danville, PA
Surgical options for pelvic prolapse (PP) have expanded with transvaginal kits increasing in popularity. Unfortunately, dyspareunia and mesh erosion (ME) is a concern, and vaginal anatomy may preclude this approach. The transabdominal colposuspension (TAC) enjoys long-term data demonstrating efficacy. The Robotic TAC offers a minimally invasive alternative. We describe our technique of Robotic TAC polypropolene mesh (PM) placement into the perineal body (PB).
Standard dissection exposes the sacral promontory (SP) and retroperitoneum to the PB. A 20 x 3 cm PM is prepared as a T-shaped graft with a 5 x 1 cm tail with a prolene stitch (PS) at the tip tied with a loop and delivered intraperitoneally. A spinal needle (SN) is passed internally through the PB by digitally identifying vagina and rectum. The PS free end is fed into the SN and both are externalized. The PS is grasped and pulled, externalizing the tail. The 3 cm portion of the PM closely abutts the internal border of the PB. The PM is cut at skin level. Internally, the PM is tacked to PB, posterior vaginal wall, apex, cervix and SP with 0 gortex and retroperitonealized.
We have performed a variety of Robotic antiincontinence and PP repairs. This is our recent modification. To date exam there is excellent anterior, posterior and apical support without ME.
Robotic TAC with PM placement is technically feasible, safe, well tolerated and cost effective. This is the first documentation of this technique in the literature to date.