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Journal of Robotic Surgery

, Volume 13, Issue 3, pp 519–523 | Cite as

Robotic-assisted laparoscopic apical suspension: description of the spiral technique

  • Hugo H. DavilaEmail author
  • Karisa Brown
  • Prajwal Dara
  • Lindsey Bruce
  • Lindsey Goodman
  • Taryn Gallo
Case Report

Abstract

This video’s objective was to describe our spiral technique and surgical steps of robotic-assisted laparoscopic apical suspension (RALAS) in the treatment of patients with symptomatic apical vaginal prolapse. A 70-year-old Caucasian woman, gravida 3, para 2 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation, the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and is sexually active. The most relevant complaints were vaginal bulging and pressure. She denied urinary incontinence. During the surgery, we used (1) 3-0, V-Loc™ (Covidien) and we reinforced these absorbable sutures with (2) 2-0, GORE-TEX® Suture (Gore Medical). The Si da Vinci Surgical System was used with 4 arms and 5 trocars configuration, docked on the patient’s left side. On the right/left apical support, we used V-Loc and Gore-Tex and these provided the initial 2 points suspension on the uterosacral ligaments (USL). We like to attach the left to the right USL. We then developed the space between the bladder and vagina and proceed with a plication of the pubocervical fascia with V-loc sutures. Two anterior apical support sutures were taken from the vagina to the transversalis fascia on the anterior abdominal wall and then hid behind the bladder peritoneum. The tension of these sutures was maintained with Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon). With the spiral technique, we secured these sutures through aponeurosis of abdominal muscle inside-outside-inside using a Carter-Thomason (Cooper Surgical) laparoscopic port closure system. This technique may provide a better long-term support for the anterior apical compartment.

Keywords

Apical prolapse Vaginal prolapse Pelvic anatomy Robotic surgery Uterosacral ligament Cardinal ligament 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Hugo H Davila, MD, Karisa Brown MS, Prajwal Dara MS, Lindsey Bruce MD, Lindsey Goodman MD and Taryn Gallo MD. Declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Consent section

Written informed consent was obtained from the patient for publication of this Case Report/any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Supplementary material

Video. Robotic-Assisted Laparoscopic Apical Suspension with spiral technique (RALAS-4 s). Descriptions of surgical steps (MP4 353885 KB)

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Hugo H. Davila
    • 1
    • 2
    • 3
    Email author
  • Karisa Brown
    • 3
  • Prajwal Dara
    • 3
  • Lindsey Bruce
    • 2
  • Lindsey Goodman
    • 2
  • Taryn Gallo
    • 2
  1. 1.Florida Healthcare Specialist, Urology and Minimally Invasive SurgeryFlorida Cancer Specialist and Research InstituteVero BeachUSA
  2. 2.Department of Surgery, Division of Urology and GynecologySebastian River Medical CenterSebastianUSA
  3. 3.Florida State University College of Medicine, Fort Pierce CampusFort PierceUSA

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