Robotic Pelvic Floor Reconstructive Surgery


In recent years, robotic surgery has been increasingly adopted as part of the surgical armamentarium for the management of pelvic floor disorders. Such disorders — including pelvic organ prolapse (uterine or vaginal prolapse, cystocele, rectocele), urinary incontinence, fistulas, and mesh-related complications (such as tissue erosion) — fall under the domain of Urogynecology and Pelvic Floor Surgery, a specialized subspecialty within Obstetrics and Gynecology.


The technological advantages of robotic systems — especially their ability to provide detailed three-dimensional visualization of complex anatomical structures and to facilitate precise tissue dissection and suturing in deep and narrow surgical fields — have made robotic surgery increasingly popular among pelvic floor reconstructive surgeons.


Although the implementation of robotic technology in pelvic floor surgery is relatively recent, available scientific data demonstrate a significantly shorter learning curve for complex procedures — such as sacrocolpopexy or sacrohysteropexy — when compared to laparoscopy. Moreover, robotic procedures are associated with lower conversion rates to open surgery compared to their laparoscopic equivalents.


A recent multicenter study (2023) involving accredited robotic pelvic floor surgeons (including urogynecologists, urologists, and colorectal surgeons) from 10 countries highlighted several key advantages of robotic-assisted pelvic floor surgery:

  • High level of procedural safety
  • Greater effectiveness than standard laparoscopic techniques
  • Technical superiority in terms of accurate dissection, mesh placement, and tissue suturing
  • Steeper learning curve for surgeons transitioning from open to robotic techniques, even without prior experience in endoscopic surgery

Common robotic-assisted urogynecologic procedures include:

  1. Sacrocolpopexy / Sacrohysteropexy with mesh
  2. Pectopexy / Pectohysteropexy with mesh
  3. High suspension of the vaginal vault to the uterosacral ligaments
  4. Burch colposuspension
  5. Removal of prolapse mesh and mid-urethral slings

References

  1. Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users. Surg Endosc. 2023 Jul;37(7):5215-5225.
  2. Robot-assisted laparoscopic pelvic floor surgery: Review. Best Pract Res Clin Obstet Gynaecol. 2023 Dec;91:102418.
  3. Surgeon satisfaction and outcomes of tele-proctoring for robotic gynecologic surgery. J Robot Surg. 2022 Jun;16(3):563–568.
  4. Laparoscopic and Robotic-assisted Vesicovaginal Fistula Repair: A Systematic Review of the Literature. J Minim Invasive Gynecol. 2015 Jul–Aug;22(5):727–736.