Robot-Assisted Laparoscopic Sacrocolpopexy

  • Shawn M. McGee
  • Mark S. ShimkoEmail author
  • Daniel S. Elliott
  • George K. Chow
Part of the Current Clinical Urology book series


The gold standard for repair of symptomatic high-grade, posthysterectomy vaginal vault prolapse is the sacrocolpopexy. Surgical routes to perform the sacrocolpopexy have included the transabdominal, transvaginal, laparoscopic, and more recently the robot-assisted laparoscopic sacrocolpopexy (RALS). The Urology Department at our institution has recently described the long-term results from the RALS. This technique has demonstrated a greater than 90% durability in repair, as defined by no recurrent pelvic organ prolapse (Elliott DS, Krambeck AE, Chow GK, J Urol 176:655–659, 2006). In addition, it has been shown that the RALS is an excellent technique for posthysterectomy vaginal vault prolapse repair with decreased hospital stays, less postoperative pain control, and similar postoperative morbidity when compared to the open transabdominal route (Elliott DS, Siddiqui SA, Chow GK, J Robotic Surg 1:163–168, 2007; McGee SM, Chow GK, Elliott DS, World Congress of Endourology, Shanghai, China, 2008; Daneshgari F, Kefer JC, Moore C, Kaouk J, BJU Int 100:875–879, 2007). The success of the sacrocolpopexy is largely due to correctly identifying the appropriate patient for the RALS. The diagnosis of vaginal vault prolapse is broad and includes female patients with or without a uterus presenting with a cystocele, rectocele, enterocele, or a combination of these. The sacrocolpopexy has traditionally been used for patients with posthysterectomy apical vaginal vault prolapse which may include a concomitant posterior or anterior vaginal vault defect (Fig. 8.1). The female patient may be a candidate for sacrocolpopexy if she suffers from high-grade apical vaginal prolapse as classified by a standardized grading system such the Baden Walker scale or Pelvic Organ Prolapse Quantification system. This chapter focuses on RALS, a technique that has evolved since our first description in patients with posthysterectomy, high-grade vaginal vault prolapse (Elliott DS, Frank I, DiMarco DS, Chow GK, Am J Surg 188:52S–56S, 2004). Urologic surgeon familiarity is noted due to the set-up of the robotic system and surgical suite, which are similar when compared to the robotic-assisted laparoscopic prostatectomy described in other chapters. As the reader will see, specific steps of the RALS have evolved, but still simulate the open repair with respect to the female anatomy and sacral mesh fixation.


Pelvic Organ Prolapse Mesh Fixation Sacral Promontory Vaginal Vault Prolapse Needle Driver 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank our surgical assistants, especially Ms. Nancy Mork, for their contributions in the operative suite.

We would also like to thank the Medical Illustration and Audiovisual Departments at Mayo Clinic for their contributions.

Supplementary material

Video 8.1 Vaginal retractor placement (9.33 MB)

Video 8.2 Vaginal dissection (15 MB)

Video 8.3 Sacal promontory and gortex suture placement (12.2 MB)

Video 8.4 Suturing mesh to vagina (18.9 MB)

Video 8.5 Suturing mesh to sacrum (8.78 MB)

Video 8.6 Retroperitonealize the mesh (8.70 MB)


  1. 1.
    Elliott DS, Krambeck AE, Chow GK (2006) Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol 176:655–659PubMedCrossRefGoogle Scholar
  2. 2.
    Elliott DS, Frank I, DiMarco DS, Chow GK (2004) Gynecologic use of the robotically assisted laparoscopy: sacrocolpopexy for the treatment of high-grade vaginal vault prolapse. Am J Surg 188:52S–56SPubMedCrossRefGoogle Scholar
  3. 3.
    Sutton GP, Addison WA, Livengood C, Hammond CB (1981) Life-threatening hemorrhage complicating sacrocolpopexy. Am J Obstet Gynecol 140:836–837PubMedGoogle Scholar
  4. 4.
    Priyanka G, Siddiqui SA, Lohse CM, McGee SM, Chow GK, Elliott DS (2008) Impact of obesity on surgical outcomes after robotic-assisted laparoscopic sacrocolpopexy. World Congress of Endourology, ShanghaiGoogle Scholar
  5. 5.
    Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, Zyczynski H (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–823PubMedCrossRefGoogle Scholar
  6. 6.
    Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH (2005) A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol 106:29–37PubMedCrossRefGoogle Scholar
  7. 7.
    McGee SM, Chow GK, Elliott DS (2008) Surgical complications of the robotically-assisted versus transabdominal sacrocolpopexy. World Congress of Endourology, ShanghaiGoogle Scholar
  8. 8.
    Elliott DS, Siddiqui SA, Chow GK (2007) Assessment of the durability of robot-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. J Robotic Surg 1:163–168CrossRefGoogle Scholar
  9. 9.
    Daneshgari F, Kefer JC, Moore C, Kaouk J (2007) Robotic abdominal sacrocolpopexy/sacrouteropexy repair of advanced female pelvic organ prolapse (POP): utilizing POP-quantification-based staging and outcomes. BJU Int 100:875–879PubMedCrossRefGoogle Scholar
  10. 10.
    Seim A, Eriksen BC, Hunskaar S (1996) A study of female urinary incontinence in general practice. Demography, medical history, and clinical findings. Scand J Urol Nephrol 30:465–471PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Shawn M. McGee
  • Mark S. Shimko
    • 1
    Email author
  • Daniel S. Elliott
  • George K. Chow
  1. 1.Department of UrologyMayo Medical School and Mayo ClinicRochesterUSA

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