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Pelvic Repair

Robotic pelvic repair refers to a minimally invasive surgical approach using robotic-assisted technology, such as the da Vinci Surgical System, to treat various pelvic floor disorders. The pelvic floor is a complex structure consisting of muscles, ligaments, and connective tissue that supports the pelvic organs, including the bladder, uterus, and rectum. Over time or due to specific factors like childbirth, aging, or surgery, the pelvic floor can weaken or get damaged, leading to disorders.

Pelvic prolapse repair addresses various forms of pelvic organ prolapse (POP), which occurs when the muscles, ligaments, and connective tissue supporting the pelvic organs weaken or become damaged. This weakening can lead to the descent or herniation of pelvic organs into or outside the vaginal canal. Several types of POP and related issues can be addressed during pelvic prolapse repair:

Cystocele: This is the prolapse of the bladder into the front wall of the vagina. It is the most common form of POP and can lead to urinary symptoms.

Rectocele: A rectocele occurs when the rectum bulges into the back wall of the vagina. It can result in difficulty with bowel movements or a feeling of rectal pressure.

Uterine Prolapse: This involves the descent of the uterus into the vaginal canal. In severe cases, the uterus may protrude outside the vagina.

Vaginal Vault Prolapse: In women who have had a hysterectomy, the top of the vagina (known as the vaginal vault) can prolapse. This condition might require a different approach, such as a sacrocolpopexy, where the vaginal vault is suspended to the sacral promontory.

Enterocele: An enterocele is the herniation of the small bowel into the upper part of the vagina, typically occurring after a hysterectomy. It can be associated with a sensation of vaginal fullness.

Urethrocele: This is the prolapse of the urethra (the tube that carries urine from the bladder to outside the body) into the front wall of the vagina. It is often seen in conjunction with a cystocele.

Functional Issues: Along with anatomical corrections, pelvic prolapse repair can address functional issues like stress urinary incontinence (SUI) or obstructed defecation.

Sexual Dysfunction: In some women, POP can contribute to discomfort or pain during intercourse. Repair can help alleviate this symptom.

Pelvic prolapse repair can be achieved through various surgical techniques, depending on the type and severity of the prolapse, the patient's age, health status, and desire for future childbearing, as well as other factors. These techniques include vaginal, abdominal (open or laparoscopic), and robotic-assisted approaches.

Prof Dr. Rehana Aamer Khan is widely acknowledged as the premier gynecological surgeon in Lahore, specializing in pelvic prolapse repair. Her substantial experience and exceptional surgical skills set her apart as a leading expert in managing complex gynecological conditions in Lahore Pakistan. Owing to her reputation for providing meticulous care and achieving optimal outcomes Patients across the Pakistan seek her expertise to address pelvic floor disorders.

Dr. Khan utilizes state of the art surgical techniques, including minimally invasive and robotic assisted procedures, to ensure precision and enhance recovery experiences for her patients. Her commitment to leveraging advanced medical technologies has been instrumental in elevating the standard of gynecological care available in Lahore Pakistan. Her unwavering commitment to excellence in women’s health has not only resulted in improved quality of life for numerous patients but has also contributed significantly to the field of gynecological surgery in Lahore Pakistan. For those in need of pelvic prolapse repair in Lahore, Prof Dr. Rehana Aamer Khan remains the most trusted and sought after specialist, synonymous with high quality care and surgical excellence in the realm of gynecology.

When Patient Need Pelvic Repair?

Pelvic floor repair is a surgical intervention aimed at correcting pelvic floor disorders. The pelvic floor consists of muscles, ligaments, and connective tissue that support the pelvic organs, including the bladder, uterus, vagina, small bowel, and rectum. Several factors can weaken the pelvic floor, leading to a range of disorders. Patients might need pelvic floor repair in the following situations:

  • Pelvic Organ Prolapse (POP): When the pelvic organs drop (prolapse) from their normal place in the lower belly and push against the walls of the vagina, it is known as pelvic organ prolapse. This can be felt as a bulge in the vagina or even seen protruding from the vaginal opening.
  • Urinary Issues:
      • Stress Urinary Incontinence (SUI): Involuntary leakage of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, or physical activity.
      • Overactive Bladder (OAB): Symptoms include frequent urination, nocturia (frequent nighttime urination), and urgency that might or might not result in incontinence.
  • Bowel Dysfunction:
      • Obstructed Defecation: Difficulty in emptying the bowels.
      • Fecal Incontinence: Inability to control bowel movements, leading to unwanted leakage.
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  • Sexual Dysfunction: Discomfort or pain during intercourse, often resulting from prolapse or other pelvic floor disorders.
  • Chronic Pelvic Pain: Persistent pain in the pelvic region that might be associated with pelvic floor muscle spasm.
  • Postpartum Complications: After childbirth, some women might experience pelvic floor damage, leading to prolapse, incontinence, or other related issues.
  • Previous Pelvic Surgery: Patients who have had pelvic surgeries and experience symptoms of pelvic floor disorders might require a repair, especially if previous surgeries contributed to or did not fully correct the issue.
  • Presence of Large or Symptomatic Pelvic Masses: Such as large fibroids that might cause pressure or pelvic discomfort.

It is crucial to note that the presence of a pelvic floor disorder does not always necessitate surgery. Many patients can benefit from non surgical interventions like pelvic floor physical therapy, lifestyle modifications, and medications. Surgery, including pelvic floor repair, is typically considered when conservative treatments don't provide sufficient relief or if the condition is severe. Decisions regarding treatment should be made in consultation with a specialist, considering the patient's symptoms, age, overall health, and personal preferences.

Robotic Pelvic Repair Procedure:

Robotic pelvic repair is a minimally invasive surgical approach that utilizes robotic assisted technology to address pelvic floor disorders like pelvic organ prolapse. Here is an overview of how the robotic pelvic repair procedure is typically performed:

Preparation:

  • The patient is placed under general anesthesia.
  • The abdomen and pelvic areas are cleaned and sterilized.

Trocar Insertion:

  • Several small incisions are made in the abdomen.
  • Trocars (small ports) are inserted into these incisions. They allow for the introduction of the robotic instruments and camera into the pelvic cavity.

Robot Docking:

  • The robotic system is positioned and then docked to the patient.
  • Surgical instruments are attached to the robotic arms and inserted through the trocars.

Visualization:

  • The surgeon sits at a console separate from the patient and controls the robotic arms.
  • A high-definition, 3D camera provides magnified views of the pelvic anatomy, allowing the surgeon to see the prolapsed organs and surrounding structures with exceptional clarity.

Repair:

  • Depending on the type and severity of the prolapse, different techniques are employed. Common procedures include sacrocolpopexy (for vaginal vault prolapse) where mesh is used to suspend the vaginal apex to the sacral promontory.
  • Robotic precision aids in accurately placing sutures and mesh, minimizing damage to surrounding tissues.

Closure:

  • After the repair is completed and the integrity of the repair is verified, the robotic instruments are withdrawn.
  • The incisions in the abdomen are closed using sutures, staples, or adhesive glue.

Recovery:

  • The patient is moved to a recovery room to wake from anesthesia.
  • Due to the minimally invasive nature of the procedure, patients often experience less post-operative pain, shorter hospital stays, and faster overall recovery compared to traditional open surgery.

The specific steps and techniques in a robotic pelvic repair procedure might vary based on the type of prolapse being addressed, the surgeon's expertise, and the specific robotic system being used. As always, a comprehensive consultation with a gynecological surgeon is essential to understand the procedure thoroughly and to determine its appropriateness for an individual's condition.

Benefits of Robotic Pelvic Floor Repair 

Robotic pelvic floor repair is an advanced surgical technique that utilizes robotic-assisted technology to address pelvic floor disorders. Compared to traditional open and even laparoscopic surgery, robotic-assisted procedures offer several benefits:

Enhanced Precision: Robotic systems provide superior hand-tremor filtering, translating the surgeon's hand movements into highly precise actions, which is particularly beneficial in the delicate structures of the pelvic region.

Superior Visualization: The robotic platform offers a high-definition, 3D magnified view of the surgical area, giving the surgeon an exceptional visual field to clearly differentiate between tissues and structures.

Greater Range of Motion: The robotic instruments can mimic the human wrist's full range of motion, providing a dexterity that surpasses conventional laparoscopic tools. This can be invaluable when working in the confined space of the pelvis.

Minimized Tissue Trauma: The enhanced precision of the robotic system often results in reduced tissue trauma, which can lead to less postoperative pain and quicker recovery.

Smaller Incisions: Robotic procedures are minimally invasive, typically requiring only a few small incisions, resulting in reduced scarring and improved cosmetic outcomes.

Shorter Recovery Time: Due to the minimally invasive nature of the procedure, patients often have a quicker recovery, reduced post-operative pain, and shorter hospital stays compared to open surgical methods.

Decreased Blood Loss: The precision and control afforded by the robotic system can lead to less blood loss during surgery.

Reduced Risk of Conversion: There might be a decreased likelihood of converting the procedure to a traditional open surgery due to complications or technical challenges.

Improved Outcomes: The combination of precision, visualization, and dexterity can potentially lead to better surgical outcomes and fewer complications.

It's important to note that while robotic pelvic floor repair offers multiple benefits, the decision to opt for this approach should be based on the individual's condition, the surgeon's expertise with robotic systems, the available facilities, and a thorough risk-benefit analysis.