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Have prolapsed uterus, a cystocele and a slight rectocele. Recommended sacrocolpopexy with mesh. Safest surgery?

I have a prolapsed uterus , a cystocele and a slight rectocele . I have been to 3 gynecologists, a urologist , and 3 urogynecologists. They all recommend sacrocolpopexy with mesh, but the approaches differ. One method is laprascopic, one is DaVinci robot laprascopic, one is an abdominal incision, and another is vaginal mesh. I am trying to decide which is the safest surgery.
Asked On : Mon, 13 Aug 2012
Answers:  1 Views:  65
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OBGYN 's  Response
Mar 2014
Hello and welcome,

I understand the problem.

The treatment plans are based upon age, desire for future children and desire to keep the uterus.
If for any reason the uterus needs to be preserved, then sling surgeries are done. If not then a vaginal hysterectomy is the easiest one for prolapse along with sacrospinous fixation.

The approach to surgery and open or laproscopy all depends upon the procedure the surgeon is most comfortable with. Vaginal approach is easy as in prolapse the uterus is down in the vagina and may be manipulated easily. Abdominal incision is preferred as the sacral promontary is easily accessible from there and sutures for fixation can be applied easily. People skilled in da vinci prefer the robotic. All approaches have their own sets of advantages and disadvantages and it all depends upon the surgeons skill and level of surgical difficulty. So safety is a relative term. The reason I do not give an opinion is that it may be biased for one approach as i use it compared to the other that may be equally good when others do it.

However recovery is earlier with a laproscopy and vaginal approach compared to abdominal incision.

So go to the surgeon who you feel is best skilled and the one that you are comfortable with and will prefer for follow up. The outcome will be always good in skilled hands irrespective of the approach.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
Answered: Thu, 3 Apr 2014
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