Greater Boston Urology Blog

Robotic Surgery for Urogynecology

We recently published an article on robotic surgery for urologic cancer. Today, we have a companion piece: robotic surgery for urogynecology.

We asked Dr. Dima Ezzedine from our Plymouth Care Center to answer some questions about how she uses robotic surgery in her urogynecology practice.

As with all content on our blog, the information provided in this article is meant to be educational in nature, not medical advice. Always consult a physician regarding your specific health needs.

First, in general terms, describe robotic surgery for urogynecology. What is it used for?

DR. EZZEDINE: Robotic surgery is a minimally invasive surgical technique that is primarily used in urogynecology to treat pelvic organ prolapse. It is performed through small abdominal incisions with the assistance of robotic surgical arms remotely controlled by the surgeon.

I perform mainly two robotic surgeries to manage pelvic organ prolapse: Robotic sacrocolpopexy and robotic total hysterectomy with bilateral high uterosacral ligament suspension.

What are the biggest benefits that robotic surgery offers?

DR. EZZEDINE: Robotic surgery has many advantages. First of all, it allows for an enhanced surgeon’s dexterity and maneuvering of instruments thanks to the robotic instruments’ 360 degrees of wrist movement. Second, the robotic system's 3D magnified camera allows for a superior visualization of organs, tissues, and surgical planes. And finally, it allows me to reach the deep aspects of the pelvis, which is especially necessary when performing prolapse surgery.

All of these advantages lead to better patient outcomes in terms of less blood loss, less post-operative pain, and quicker healing and return to normal activity.

Does insurance typically cover urogynecologic robotic surgery?

DR. EZZEDINE: Yes, robotic surgery in urogynecology, as in many other surgical specialties, is nowadays a common surgical approach, and it is covered by insurance companies.

Now let's talk about robotic sacrocolpopexy. When would this treatment option be considered? What does it entail?

DR. EZZEDINE: Robotic sacrocolpopexy is usually considered when women present with either bothersome uterine prolapse or vaginal vault prolapse (if they previously had a hysterectomy). Both conditions go under the umbrella of “apical prolapse,” which means that the top of the vagina—the highest/deepest part of the vaginal canal—has everted (in other words, turned inside out).

Robotic sacrocolpopexy can also be considered when other aspects of the vagina have prolapsed along with the vaginal apex, such as the anterior wall dragging along the bladder or the posterior wall usually dragging along the rectum.

Sacrocolpopexy entails the use of a surgical mesh that lifts up the prolapsed vagina inside of a woman’s body and connects it to a strong ligament covering the sacrum. This surgery has the highest success rate among all reconstructive (corrective) vaginal prolapse surgeries that reaches up to 90%.

Of course each woman’s condition is unique, and robotic sacrocolpopexy is only one of many options available to treat pelvic organ prolapse. A thorough medical evaluation and exam as well as a discussion of the benefits risks and alternative are necessary before making a shared decision concerning the best surgical treatment for the individual patient.

And what about robotic total hysterectomy with bilateral high uterosacral ligament suspension. When would you offer this option? What does it entail?

DR. EZZEDINE: This procedure is primarily offered to women with a predominantly apical uterovaginal prolapse. The main difference between this procedure and robotic sacrocolpopexy is the fact that no mesh is used for this surgery, which makes it suitable for those who wish to avoid mesh.

It entails performing a total hysterectomy robotically followed by connecting the vaginal cuff (top of the vaginal canal after removal of the uterus) with sutures to the most proximal (highest point possible) part of the uterosacral ligaments (the actual ligaments that naturally support the cervix and upper vagina). This allows us to lift the top of the vagina up inside and restore normal anatomy of the vaginal canal.

If there's one point about robotic surgery that you want to make sure readers take away, what would it be?

DR. EZZEDINE: I would like the readers to know that robotic surgery is an excellent surgical route for management of pelvic organ prolapse. It is, however, not the only option. I am here to help my patients decide the best surgical treatment option for them following a thorough evaluation and discussion of their preferences, options, risks, benefits, and personal goals.

Interested in making an appointment with Dr. Ezzedine?

Dr. Ezzedine is accepting new patients in our Plymouth Care Center. Click here to make an appointment with her.

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