Single-Port Robotic-Assisted Laparoscopic Sacrocolpopexy With Magnetic Retraction: A Video Demonstration

Abdominal sacrocolpopexy is the gold standard for treatment of apical prolapse.1 Minimally invasive surgery offers many advantages over the open approach, including incision size, blood loss, postoperative pain while maintaining similar long-term outcomes.2,3 OBJECTIVE: To assess the safety and feasibility of performing a magnetic-assisted single-port robotic sacrocolpopexy (MARS).Prior to surgery, a magnetic controller was secured to the surgical bed. The Hassan technique was used to place a 25 mm SP port through a single 2.5 cm supra-umbilical incision. A 12 mm assistant port was placed 10 cm lateral to the SP port on the right side, this additional trocar placement may be obviated by using a gel-point for both ports. The SP robot was docked on the right side of the bed. The magnet was clipped onto the sigmoid mesentery and the outer magnet was repositioned to retract the sigmoid laterally. The sacral promontory was exposed, and the peritoneal incision was carried down to the vagina. The magnet was repositioned, and the bladder was reflected off the anterior vagina. The posterior dissection was carried out to reveal the posterior vagina. "Y" mesh was placed, appropriately tensioned, secured to the sacral promontory and retroperitonealized. Cystoscopy was performed. The magnet was removed from the sigmoid colon, and all incisions were closed.A 66-year-old G2P2 female, BMI 25, status-post prior abdominal hysterectomy presented with symptomatic stage IV prolapse. Surgery was uneventful with an operative time of 247 minutes and an estimated blood loss of 10cc. The patient was discharged the following day. At 3 months postoperatively, she had anatomic and symptomatic resolution of her prolapse.Using magnetic assistance, MARS can be offered to women who want a durable option for prolapse repair with improved cosmesis compared to conventional methods and may offer cosmetic benefits when paired with a concurrent hysterectomy.