Pelvic organ prolapse can disrupt comfort, mobility, and confidence in everyday life. Women facing this issue often feel overwhelmed when choosing the right surgical solution.
Robot-assisted sacrocolpopexy is gaining popularity, but not everyone understands how it performs. Traditional options like transvaginal mesh come with a long history and ongoing debate. Is robotic surgery safer, or do both methods carry similar risks? Do the outcomes justify the rising use of surgical robots?Â
So, how do these two surgical options compare when studied side by side? This post covers the fundamentals and explains how recent research compares both surgeries.
What Is a Transvaginal Mesh?
Mayo Clinic mentions that a medical implant called a pelvic mesh is used to replace weak or damaged tissue in a woman’s pelvic region. It can be made of biological or synthetic materials.
Surgeons implant mesh to permanently address ailments like stress urinary incontinence and pelvic organ prolapse. The urethra, bladder neck, and vaginal wall are supported by the mesh.
It is commonly made from plastic polymers like polypropylene or tissue derived from animals. When surgically placed, the mesh is designed to hold tissues in their proper position.
FDA Actions Amid Safety Concerns
Drugwatch notes that due to safety concerns, the FDA has taken steps to limit the use of transvaginal mesh.Â
Numerous reports of complications and side effects led the FDA to determine that the risks posed by the mesh outweigh its benefits. Manufacturers were ordered to stop selling and distributing transvaginal mesh kits for POP in 2019.
However, mesh devices have not been subject to an official recall. Mid-urethral slings and abdominal surgeries using mesh are still permitted. Ongoing oversight aims to protect women’s health and safety.
Complications Associated with Transvaginal Mesh
According to TorHoerman Law, some of the main issues associated with the vaginal mesh include pain, bleeding, and organ perforation. Other complications include erosion of the mesh into surrounding tissues, infection, and urinary problems. Recurrence of prolapse or incontinence and chronic pelvic pain have also been reported.
A study published by MDPI examined data from several studies comparing surgical outcomes of laparoscopic and transvaginal mesh procedures for POP repair. The review found that transvaginal mesh placement had major complications requiring intervention in about 5–9% of cases.
This was higher compared to less than 5% for laparoscopic approaches. Transvaginal mesh also showed higher prolapse recurrence rates, exceeding 25% at seven years of follow-up.
Laparoscopic approaches had under 25% recurrence rates at nine years. Based on these findings, researchers concluded that laparoscopic mesh placement may offer better long-term outcomes.
The severity of reported mesh complications has led many women to file a transvaginal mesh lawsuit against mesh manufacturers. The plaintiffs allege that the products caused painful injuries. Additionally, they assert that the companies misrepresented the efficacy and safety of the implants. Thousands of cases have been brought forward nationwide.
What is Robotic Sacrocolpopexy?
Robotic sacrocolpopexy is a less invasive surgical technique designed to repair pelvic organ prolapse in women. During the procedure, the top of the vagina is secured to the sacrum using a mesh implant.
The use of robotic technology allows surgeons to operate with accuracy, often resulting in shorter recovery times and reduced discomfort than conventional surgical methods.
Complications Associated with Robotic Sacrocolpopexy
Although robotic sacrocolpopexy is generally safe, like any surgery, it carries potential risks and complications. These may include:
- Infection: Any surgical procedure carries a risk of infection at the incision site or within the pelvic cavity.
- Injury to surrounding organs: The nearby bladder, ureters, rectum, or blood vessels can sometimes be injured during the surgery.
- Mesh complications: There is a risk of the mesh becoming eroded, which could cause pain, urinary problems, or other issues.
- Urinary or bowel dysfunction: Temporary or permanent changes in urinary or bowel function can occur as a result of the surgery.
- Blood clots: As with any major surgery, there is a risk of developing blood clots, particularly in the legs.
Even though these risks are present, they’re less prevalent than those linked to mesh implants. Robotic sacrocolpopexy generally provides significant benefits, including faster recovery and fewer complications compared to traditional surgery.
Comparing Robotic Sacrocolpopexy and Transvaginal Mesh
Researchers recently carried out a study on two surgical treatments for pelvic organ prolapse. The focus was on how each procedure affects bladder function in women.
ScienceDirect reports that the study analyzed outcomes of robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM). Participants completed questionnaires and underwent tests to check bladder function before and after their procedures.
The study found that women undergoing robotic sacrocolpopexy experienced higher rates of newly developed stress urinary incontinence than those treated with TVM. In both surgical groups, bladder closure pressure was reduced following the procedure. However, RSC patients experienced a more noticeable increase in stress incontinence.
Both surgical methods helped relieve some bladder-related symptoms. Patients in both groups reported improvements in issues like urine retention and trouble emptying the bladder. These positive changes suggest that both procedures offer some level of relief from the urinary challenges linked to pelvic organ prolapse.
However, the increased risk of developing new stress urinary incontinence after robotic sacrocolpopexy raises concerns. For women considering surgical treatment, this information is important to weigh when choosing between options.
FAQs
Is there a non-surgical alternative to transvaginal mesh?
For women with mild pelvic organ prolapse or those who are not surgical candidates, non-invasive treatments may help. Pelvic floor strengthening exercises and the use of pessary devices are common alternatives. However, they are less effective than surgical treatments in severe cases of prolapse.
Can robotic sacrocolpopexy be performed on all patients?
Robotic sacrocolpopexy isn’t ideal for everyone and may not work for all cases. Women with specific medical issues or significant pelvic abnormalities might not experience good results from this surgery. A thorough pre-surgical evaluation helps determine if robotic surgery is the best option for an individual patient.
How can complications be minimized during robotic sacrocolpopexy?
Choosing an experienced surgeon and undergoing a thorough pre-surgical evaluation are essential to minimizing complications. Surgeons should carefully follow guidelines for proper mesh placement and monitor for complications. Postoperative care, including follow-up visits, also helps detect issues early.
Robotic sacrocolpopexy may be a better option for treating pelvic organ prolapse today. Transvaginal mesh has shown higher rates of complications and recurrence over the years. Robotic surgery is not risk-free, with some patients developing new stress urinary incontinence post-op.
Even with that concern, fewer overall complications make robotic methods appealing to many women. Long-term outcomes from robotic sacrocolpopexy are often more favorable than traditional mesh procedures. Each case requires a personalized surgical plan based on the patient’s specific needs.
