V84 - Single-Port Robotic Ventral Mesh Rectopexy

Purpose/Background: A 46-year-old woman presented to clinic with symptomatic rectal prolapse. On exam, she had a 4 cm full thickness rectal prolapse and a small umbilical hernia. After discussion with the patient, decision was made to proceed with ventral mesh rectopexy, with plans to utilize the umbilical hernia as the single port access site.

Methods/Interventions: A 3cm infraumbilical incision was made and entrance into the abdomen was made through the existing 1 cm umbilical hernia. The SP access port was then placed and the robot was docked.

The rectum was elevated, and the sacral promontory was exposed for stitch placement. The TME plane was developed in the posterior and right lateral directions, making sure to protect the hypogastric nerves and important vasculature. Anteriorly, the rectum and vagina were separated to the level of the perineal body. Anorectal exam was performed to confirm adequacy of the dissection. A 3x15 cm polypropylene mesh was then secured to the anterior rectum and the sacral promontory. The peritoneum was closed over the mesh. Inspection of the abdominal cavity showed adequate hemostasis and no iatrogenic injury. The port was then removed. The 1 cm umbilical hernia was then closed with 2-0 strata fix and the skin was closed with Monocryl.

Results/Outcomes: The patient did well and was discharged from the recovery room.

Conclusion/Discussion: The SP robotic system has seen increased utilization in an expanding range of applications. One important advantage of the SP system is the smaller skin incision and improved cosmesis. In this patient, the SP system allowed the surgery to be performed through an existing umbilical hernia, maximizing the cosmetic outcome. In the future, utilization of this technique may provide the same surgical outcomes while improving patient satisfaction.