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Advanced Gynecologic Surgery, Norwalk CT

Sacrocolpopexy

What is sacrocolpopexy?

Sacrocolpopexy is a procedure that uses soft synthetic mesh to support pelvic organs that have slipped out of their normal positions, also known as pelvic organ prolapse.  The mesh is initially held in place by suturing to the sacrum from strap-like arms of mesh material woven through the pelvis. Body tissues then grow through the mesh, augmenting the final support. This minimally invasive surgery requires two hours operative time under general anesthesia. Sacrocolpopexy can be performed following a hysterectomy to provide long-term support of the vagina.

Sacrocolpopexy was first described in 1960 as procedure involving a wide cut in the abdominal wall. The success rate was so high that it quickly became accepted as the gold standard for treatment of pelvic organ prolapse. Unfortunately, the large midline incision is associated with increased blood loss, prolonged recuperation and high rates of postoperative complications. Laparoscopically, many of these problems were overcome, but the procedure is frequently too complex to accomplish with laparoscopic instruments.

Dr. Garofalo offers a procedure called da Vinci Sacrocolpopexy, which offers the advantages of laparoscopy but with the control and precision needed for a procedure of this complexity. Part of the da Vinci® Surgical System. da Vinci Sacrocolpopexy is a state-of-the-art surgical procedure that uses very small abdominal incisions and computer technology to convert Dr. Garofalo’s hand movements into precise micro-movements of the da Vinci instruments.

Unlike vaginal suspension procedures, which are performed by vaginal access, sacrocolpopexy is performed by abdominal or laparoscopic access. Another difference is that vaginal suspension procedures suspend the synthetic mesh from pelvic ligaments, while sacrocolpopexy suspends the mesh from the sacrum – a large, triangular bone at the base of the spine. These differences result in a more accurate repair when using sacrocolpopexy, with lower failure rates and fewer associated complications.

Compared to open surgery, women who undergo sacrocolpopexy typically experience less pain, bleeding, and scarring, with a shorter hospital stay and faster recovery.

What risks are associated with sacrocolpopexy?

Although complications associated with sacrocolpopexy are unlikely, they can include difficulty urinating and possible injury to blood vessels, nerves, bladder and bowel. There is also a small risk of the mesh material becoming exposed in the vaginal canal. These conditions can be repaired with surgery. Temporary leg pain may also occur.

In 2019 the FDA recalled the use of vaginal mesh for the repair of pelvic organ prolapse.  It is important not to confuse this recall with the mesh insertion performed through sacrocolpopexy or suburethral sling procedures.  When inserted abdominally, the mesh has a significantly lower rate of complication and is still considered the gold standard for the treatment of pelvic organ prolapse.

Sacrocolpopexy is not appropriate for pregnant women or for women planning future pregnancies.

What is the recovery period following sacrocolpopexy?

Patients usually return home the day after a sacrocolpopexy procedure. Many patients resume most normal daily activities within four days and recover in two to three weeks. Heavy lifting, strenuous exercise and sexual intercourse should be avoided for up to six weeks.