In spring 2019, my UT Southwestern colleagues and I recognized an opportunity to provide next-level robotic surgery for women with pelvic organ prolapse (POP).
We performed the first single port procedure in Texas – UT Southwestern has one of just a dozen of these robotic surgery machines in the world – to help women control the uncomfortable, annoying POP symptoms with a less invasive surgical approach.
POP affects nearly one-third of women in their lifetimes. The muscles supporting the bladder, uterus, and rectum become weak and sag into the vagina, causing incontinence and pressure in the pelvic area. Some women have likened the sensation to sitting on a baseball.
The current minimally invasive surgery (sacrocolpopexy) requires five small incisions in the abdomen. Using a DaVinci robot, we place safe, effective mesh material in the pelvis over the vagina to support the pelvic organs. Our new approach requires just one small incision instead of five – an 80% reduction in scarring.
Today, the Intuitive SP platform is currently only approved by the FDA for limited prostate and kidney surgeries, and recently for some lung and oral procedures. I received special permission from the directors of the urologic surgery department and surgery services to use the SP robot for POP surgery in an effort to give more women better outcomes – and initial results are promising.
Is one port better than five?
Many patients want procedures that will reduce scarring and effectively treat POP symptoms. The new SP robot by Intuitive allows us to do just that.
With the SP robot, we make one 2.5 cm long incision above the belly button. Through the incision, we place a cannula – a slender tube attached to the robot. Through the cannula, we guide four slim robotic arms attached to a tiny surgical camera and delicate instruments, which we maneuver from a control panel to place the mesh in the pelvis.
We use an ultralight mesh that has been proven safe and effective for pelvic organ prolapse. This is not the same as transvaginal mesh, which was banned by the U.S. Food and Drug Administration (FDA) in 2019.
With the SP approach, the surgeon’s field of vision is about the size of a grapefruit rather than the whole abdomen, and the robotic arms flex differently than the previous robot. These differences result in less room for the surgeon to operate, which requires expertise.
The differences also mean no incisions in a patient’s sides, which can result in quicker recovery with less discomfort. Our patients who’ve had SP surgery have stayed one night in the hospital after surgery; most patients who have the current minimally invasive approach also stay one night.
What’s the future of SP surgery for POP?
Today, we offer SP sacrocolpopexy for patients who meet these criteria. Patients must have:
- Already had a hysterectomy
- A body mass index (BMI) of 30 or less
- Had limited abdominal surgeries
These criteria offer surgeons maximum visibility and maneuverability in the abdomen. The next step is to offer the SP approach to women who have not had a hysterectomy (we could remove the uterus at the same time).
As we perform more SP sacrocolpopexy procedures, we will report anonymized data to the FDA. The ultimate goal will be FDA approval of the procedure for pelvic organ prolapse.
In the meantime, we are offering the procedure on a case-by-case basis.
One of the many reasons I enjoy working at UT Southwestern is that we are always pushing the envelope – always striving to bring our patients the best care with the latest medical technology.