Utilizing the Single-Port Robot for Sacrocolpopexy and Hysterectomy To Empower Patients

Cleveland Clinic urologists are reporting favorable outcomes using the single-port robotic system for sacrocolpopexy and hysterectomy, two surgeries often combined to effectively repair pelvic organ prolapse. The successful completion of two cases makes the center one of only few in the world to use the single-port robot for this surgery.

Pelvic organ prolapse is common, occurring in up to 11% of women in the U.S., according to reports. Apical prolapse is characterized by the descent of the uterus, cervix or vaginal vault. Sacrocolpopexy, the tried-and-true method for surgical treatment, has historically been performed with an open approach, although, more recently, urologic surgeons have opted for robotic and laparoscopic approaches.

A cosmetic advantage and empowering women

On moving from a multiport to single-port robot, Ly Hoang Roberts, MD, says, “Instead of making five incisions on the belly, you make one small incision right at the belly button, which can mean less pain and a better cosmetic appearance.” Dr. Hoang Roberts is the urologist and reconstructive pelvic surgeon who led these cases. Her practice includes treating pelvic floor dysfunction and urinary issues in women, and pelvic organ prolapse is a significant portion of the patient population she treats.

Pelvic organ prolapse is often related to a weakened pelvic floor due to age-related atrophy or childbirth. An important aspect of her practice is empowering women to feel comfortable in their skin and help contribute to a positive self-image. The option to “hide” the incision in the belly button is a small but impactful way to support that philosophy in this patient population.

Two cases completed so far

Dr. Hoang Roberts says both cases went well with no complications: one patient went home the same day of surgery, and the other was discharged the following day. Both reported minimal pain and were effusive about the cosmetic outcome. The total operative time and the postoperative pain regimens were both comparable.

From a technical perspective, the single-port robot is well-suited for hysterectomy, in addition to repairing prolapse:

“If the multiport was used for a cervix-sparing hysterectomy, one of the incisions would have to be extended at the end to remove the uterus. This would be a larger incision in addition to the four other incisions needed for the robotic ports,” she explains.

On the single-port robot, she continues, “You can use the 2.5 cm incision made at the beginning of the case to extract the uterus without any additional extension or specimen bag.” She calls it a “smoother, more elegant approach with less equipment.”

The total operative time and the postoperative pain regimens were both comparable; although, this remains an area of interest for further evaluation.

Adopting a new approach

There is understandably a learning curve associated with adopting a new operative tool; however, she calls it an intuitive experience overall. “The beauty of the single port is that it works in a smaller field, so you maneuver the robot around adhesions and work in small spaces, but it is a different frame of mind than the multiport,” she says.

Cleveland Clinic Urology has been a pioneer in robotic urologic surgeries, owing to its access to the single-port robotic system and the expert training. She is enthusiastic about adding one more surgical option for her patients.

“Our case series of two and other smaller retrospective studies demonstrate this is a safe approach. Safety is my top priority. From there, if we can introduce techniques that confer additional benefits, like cosmesis or less pain, for example, we should absolutely appreciate that this is valuable to our patients—and something we as a field—should incorporate into practice.”