Incontinence and Pelvic Organ Prolapse Surgery

  • Óscar Sánchez-Resendis
  • José María Mojarra-Estrada
  • Juan Arriaga
  • Eduardo Rivas-Larrauri
  • Lionel Leroy-López


Since the Food and Drug Administration (FDA), USA granted its approval to use the da Vinci Robotic Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for gynecological practice, it has been documented that the advantages of robotics apply well to urogynecologic procedures. The two most common operative techniques in this area are Burch’s procedure for stress urinary incontinence and sacrocolpopexy for correct the pelvic organs prolapse. During both procedures, complications can arise. The most common in retropubic cystourethropexy are injuries to the urinary organs during dissection and suture fixation; vascular damage, ureteral entrapment, and obturator nerve damage can occur, furthermore others less frequent that have been reported. Regarding to sacrocolpopexy, vascular injuries to promontory and iliac vessels may occur, mesh erosion and migration is an important issue and rarely but osteomyelitis can befall. It is mandatory to understand the anatomy of the Retzius and presacral spaces to avoid the mentioned complications, as well to be prepared to control and repair of the injuries in these procedures, with patience and efficiency. Proved skills in laparoscopic and robotic suturing is mandatory for the appropriate performance of urogynecologic procedures. In this chapter, the complications reported and how to resolve them are described.


Robotics Burch procedure Sacrocolpopexy Cistouretropexy Urogynecologic Stress urinary incontinence Pelvic organ prolapse Mesh erosion 


  1. 1.
    Parkes IL, Shveiky D. Sacrocolpopexy for treatment of vaginal apical prolapse: evidence-based surgery. J Minim Invasive Gynecol. 2014;21:546–57.CrossRefPubMedGoogle Scholar
  2. 2.
    Ulubay M, Dede M, Ozturk M, Keskin U, Fidan U, Alanbay I, Rıza K, Yenen MC. Hysterectomy with concomitant Burch colposuspension: preluminary study obstetrics abstracts. J Minim Invasive Gynecol. 2015;22:S1–S253.CrossRefGoogle Scholar
  3. 3.
    Wechter ME, Mohd J, Magrina JF, Cornella JL, Magtibay PM, Wilson JR, Kho RM. Complications in robotic-assisted gynecologic surgery according to case type: a 6-year retrospective cohort study using Clavien-Dindo classification. J Minim Invasive Gynecol. 2014;21:844–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Ghomi A, Kramer C, Askari R, Chavan NR, Einarsson JI. Trendelenburg position in gynecologic robotic-assisted surgery. J Minim Invasive Gynecol. 2012;19:485–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of convencional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynecol Obstet. 2016;132:284–91.CrossRefGoogle Scholar
  6. 6.
    Sass B, Lotze P. Knowing the relevant anatomy related to the abdominal sacrocolpopexy abstracts. J Minim Invasive Gynecol. 2014;21:S25–48.CrossRefGoogle Scholar
  7. 7.
    Chen H, Chen C, Liu M. Comparison of perioperative complications between of robotics and laparoscopy approaches in the management of gynecologic malignances abstracts. J Minim Invasive Gynecol. 2015;22:S238–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Yim GW, Kim SW, Nam EJ, Kim S, Kim Y. Perioperative complications of robot-assisted laparoscopic surgery using three robotic arms at a single institution. Yonsei Med J. 2015;56:474–81.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Giarenis I, Mastoroudes H, Cardozo L, et al. What do we do when a midurethral tape fails? Rediscovery of open colposuspension as a salvage continence operation. Int Urogynecol J. 2012;23:1117–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Long J, Magrina J. Robotic Burch coloposuspension and paravaginal defect repair procedures. J Minim Invasive Gynecol. 2007;14:S146.CrossRefGoogle Scholar
  11. 11.
    Speights S, Moore RD, Miklos JR. Frequency of lower urinary tract injury at laparoscopic burch and paravaginal repair. Review of 171 cases. J Am Assoc Gynecol Laparosc. 2000;7:515–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Stevenson K, Cholhan H, Hartmann D, et al. Lower urinary tract injury during Burch procedure. Am J Obstet Gynecol. 1999;1999(181):35–8.CrossRefGoogle Scholar
  13. 13.
    Olsen A, Smith V, Bergstrom J, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Borstad E, Abdelnoor M, Staff A, et al. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. Int Urogynecol J. 2010;21:179–86.CrossRefPubMedGoogle Scholar
  15. 15.
    Wei J, Nygaard I, Richter H, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366:2358–67.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Abdel-Fattah M, Familusi A, Bhattacharya S, et al. Epidemiology of primary and repeat surgical treatment for pelvic organ prolapse and/or stress urinary incontinence. UK BMJ. 2011;Open1(2):e000206.Google Scholar
  17. 17.
    Niladri S, Timothy H. Urogynecological risk assessment in postmenopausal women. Expert Rev of Obstet Gynecol. 2013;8:625–37.CrossRefGoogle Scholar
  18. 18.
    Costantini E, Lazzeri M, Bini V, Del Zingaro M, Frumenzio E, Poreno M. Pelvic organ prolapse repair with and without concomitant burch colposuspension in incontinent women: a randomised controlled trial with at least 5-year follow up. Obstet Gynecol Int. 2012;2012:967923.CrossRefPubMedGoogle Scholar
  19. 19.
    Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S, Uccella S, Cromi A, Ghezzi F. Robot-assisted Sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol. 2014;66:303–18.CrossRefPubMedGoogle Scholar
  20. 20.
    Sinha R, Sanjay M, Rupa B, Kumari S. Robotic surgery in gynecology. J Minim Access Surg. 2015;11:50–9.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Siddiqui N, Geller E, Visco A. Syntomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol. 2012;206:e1–5.CrossRefGoogle Scholar
  22. 22.
    Liu C, Paek W. Laparoscopic retropubic colposuspension (Burch procedure). J Am Assoc Gynecol Laparosc. 1993;1:31–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Nezhat CR. When will video-assisted and robotic-assisted endoscopy replace almost all open surgeries? J Minim Invasive Gynecol. 2015;19:238–43.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Óscar Sánchez-Resendis
    • 1
  • José María Mojarra-Estrada
    • 2
  • Juan Arriaga
    • 3
  • Eduardo Rivas-Larrauri
    • 4
  • Lionel Leroy-López
    • 5
  1. 1.Department of Gynecology EndoscopyUNIDIM, S.A. de C.V.CelayaMexico
  2. 2.Hospital CIMA Hermosillo, Infertility UnitHermosilloMexico
  3. 3.Hospital CIMA Hermosillo, UMANO Department of UrologyHermosilloMexico
  4. 4.Department of Gynecology and ObstetricsInstitute for Social Security and Services for State Employees (ISSSTE)CelayaMexico
  5. 5.“Hospital 20 de Noviembre ISSSTE”, Department of Gynecology and ObstetricsMexico CityMexico

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