V10-02: TOTAL AUTOLOGOUS FASCIA LATA ROBOTIC SACROCOLPOPEXY: A NEW TECHNIQUE
The reclassification of vaginal mesh to a high risk device for treatment of pelvic organ prolapse has prompted many patients to desire only native tissue repairs. This poses a problem for robotic sacrocolpopexy which has historically utilized a synthetic or biologic foreign graft. Our objective was to develop a technique for robotic sacrocolpopexy using autologous fascia lata graft for patients desiring pelvic organ prolapse repair with only their own tissue.
The video demonstrates our technique for Total Autologous Fascia Lata Robotic Sacrocolpopexy. Autologous fascia lata of suitable size (4 X 16 cm up to 5 X 18 cm) is harvested through a minimally invasive, 4 cm, lateral upper thigh incision. The graft is cut into 2 pieces and made into a traditional Y-shaped configuration using CV-2 Goretex sutures. The graft is introduced through the 12 mm assistant port and used to perform robotic sacrocolpopexy. Patients were followed with subjective SEAPI scores, visual analog pain (VAP) scores (range 0-10), pelvic examination (Baden-Walker grading), and examination of the thigh harvest site.
The Total Autologous Fascia Lata Robotic Sacrocolpopexy has been performed on 5 patients with a mean age of 61 and a mean follow-up of 5.2 weeks. Four patients were post-hysterectomy and one patient underwent concurrent hysterectomy. Two patients underwent concurrent sigmoid resection and rectopexy for rectal prolapse and one patient underwent concurrent autologous pubovaginal sling. Symptoms of pelvic organ prolapse resolved in all 5 patients, and mean Baden-Walker grading was 0, 0, and 0.2 in the anterior, apical, and posterior compartments, respectively. Two patients complained of de novo stress incontinence and 3 patients had unchanged urge incontinence on postoperative SEAPI scoring. One patient required lysis of a concurrent pubovaginal sling 5 weeks postoperatively for urinary retention. The mean VAP score at the harvest site was 0.6, and 3 patients developed parathesia near the harvest site. One patient developed a painless thigh hernia and 2 patients developed a seroma at the harvest site all of which were managed expectantly.
Total Autologous Fascia Lata Robotic Sacrocolpopexy is a feasible alternative to mesh sacrocolpopexy in the post-mesh era and appears to be safe and efficacious with short-term follow-up. Longer follow-up is needed to determine the long term success and possible complications of the procedure. Although self-reported pain scores were low, patients should be aware of the risk of possible development of postoperative thigh hernia or seroma at the harvest site.