Robotic-assisted Laparoscopic Sacrocolpopexy for Vaginal Vault Prolapse

Proprietary Names: da Vinci Surgical System; da Vinci S Surgical System; da Vinci S High Definition (HD) Surgical System; da Vinci Si HD Surgical System; EndoWrist instrumentation; Intuitive motion

Generic Device Names: remote surgical manipulator; robotic surgical platform; robotic surgical system; robotic telemanipulator system; surgical robot; telesurgical system

The da Vinci S robotic-assisted surgery system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) includes a surgeon console, a computerized control system, a patient side cart containing three integrated instrument arms, and a fourth arm that has a binocular endoscope with a fiberoptic camera. The da Vinci Si HD Surgical System, the newest system model, features an enhanced three-dimensional (3-D), HD vision system that provides 10X magnification; an updated user interface; improved ergonomics and operating room (OR) integration controls; digital zoom; adjusted aspect ratios that provide more viewing area; a motorized patient cart; and an optional second surgeon console with intercom that can be used for dual-surgeon procedures or for training during a procedure. One of the da Vinci system arms holds the laparoscope while the other arms hold various surgical implements. These proprietary laparoscopic instruments have grasping or cutting end-effectors that attach to the robotic instrument arms. The surgeon sits at a computer console in the OR and views the operative field that shows the view from a video camera mounted on one of the robotic arms. While watching the monitor in real time at the console, the primary surgeon uses master controls to operate the robotic arms. A second surgeon may assist directly at the operating table several feet away or at the second console.

Open abdominal sacrocolpopexy, which involves using permanent mesh to affix the vaginal vault to the anterior longitudinal ligament of the sacrum for support of the pelvic floor, is a standard surgical treatment for apical vaginal vault prolapse. Surgeons can also perform this procedure laparoscopically, but this approach has not been widely adopted because of the complex suturing and dissection involved. A trained surgeon may use any of the da Vinci systems to perform robotic-assisted laparoscopic sacrocolpopexy (RALS). According to Intuitive, the potential benefits of RALS compared to open sacrocolpopexy for the patient include the following:

Advantages of laparoscopic robotic-assisted surgery cited by surgeons include magnification in the 3-D visual field; greater surgical precision and dexterity due to wristed instruments, which have seven degrees of freedom; improved surgical access in the pelvic cavity; hand-tremor filtration; autonomy; and ergonomic comfort. Surgeons state that these technical features offer superior visualization, enhanced depth perception, and better dexterity. Also, some clinical experts feel that robotics may allow a surgeon to offer a minimally invasive approach to more patients, stating that standard laparoscopic techniques are more difficult to learn than robotic-assisted techniques and often require a skilled first assistant. Robotics may also allow a surgeon to offer minimally invasive surgery to patients who are obese or have significant adhesive disease. According to Intuitive, RALS offers the following specific benefits for the surgeon: improved access to the pelvis compared to other surgical approaches; easier, more precise dissections; improved handling of suture and...