There is only one best surgery for pelvic organ prolapse (uterine prolapse, cystocele, rectocele, enterocele). Most urogynecologists and gynecologists would agree that best surgery is the sacrocolpopexy. The Sacrocolpopexy has been around for 40 years and has the best long term results. The procedure typically involves a subtotal hysterectomy (removing the top of the uterus – but leaving the cervix). The cervical stump is then attached to the sacral promontory with permanent material.
The best, state-of the-art minimally invasive approach to performing the sacrocolpopexy, is with the da Viinci Robotic System. The da Vinci System is a surgeon-controlled robot that controls laparoscopic instruments to effect the repair while minimizing tissue trauma. The end result is that the best operation there is can now be done with less pain, quicker recovery, lower blood loss, less risk of infection, reduced scarring, and improved cosmesis with smaller incisions than ever before. Because the procedure is done without a big abdominal incision and without splitting muscle, the recovery is very quick and the post-operative pain is minimized.
Dr. Vardy has been credentialed in Robotics on the da Vinci at Mount Sinai School of Medicine since 2007. In the fall of 2009 Englewood Hospital purchased the best of the da Vinci systems, the da Vinci Si, for $1.7 million. In November, 2009, Dr. Vardy became the first surgeon credentialed by the Robotics Committee at Englewood Hospital and Medical Center and he established the robotic urogynecology program at Englewood Hospital. While the robotic sacrocolpopexy is not for everyone with prolapse, when it is indicated it offers the surgery with the best long term success rate and the lowest risk of causing pain during sex. After the first two years of the program we have seen dramatically reduced blood loss, more rapid recovery and reduced infection. Patients have typically spent one night in the hospital and have needed much less pain medications to control their post-operative pain – even on the day of surgery. Many patients have been sent home even on the day of surgery. This option is only available if everything goes perfectly AND only if the patient WANTS to go home.
The major disadvantage of the robotic surgery is the length of the surgery which has ranged from 2.5 to 5 hours (including a supracervical hysterectomy and usually an incontinence procedure as well). As the techniques have improved, the most recent cases have all been completed in under 2:45 hours. At the national and international urogynecology meetings over the past 3 years there has been an increasing focus on the robotic gold standard in prolapse surgery.
Robotics at Englewood Hospital, and affiliate of Mt Sinai School of Medicine
Robotics and Prolapse Surgery (for cystocele, rectocele, uterine prolapse and enterocele)
Video explanation of da Vinci (click here)
