Robotic Ventral Mesh Rectopexy, Robotic Rectocele Repair, and Sacrocolpopexy

Objectives: Mesh rectopexy has traditionally involved complete posterior and anterior mobilization of the rectum, however these techniques are associated with significant constipation and dyschezia likely due to disruption of pelvic nerve plexus. Mesh rectopexy has evolved to now include ventral mobilization of the rectum to the level of the levator ani muscles, and ventral attachment of polypropylene mesh to the rectum and sacrum. For patients with rectal prolapse, perineal descent, and vaginal prolapse, a robotic approach to all three defects has not previously been demonstrated by video. The objective of this video is to demonstrates a method of robotic ventral mesh rectopexy, robotic rectocele repair, and sacrocolpopexy.

Methods: We demonstrate a technique to robotic ventral mesh rectopexy, intracorporeal plication of the ventral rectum, and sacrocolpopexy for a patient with obstructive defecation, rectal prolapse, perineal descent, and posterior predominate Stage II pelvic organ prolapse.

Clinical Relevance: Post-operatively, the patient has experienced resolution of her obstructive defecation and has normal vaginal support. After complete assessment of other contributing factors to obstructed defecation syndrome, ventral mesh rectopexy, rectocele repair, and sacrocolpopexy can be considered for women with anatomic disruption of the posterior compartment who also have vaginal prolapse.