Da Vinci Robotic Laparoscopic Sacrocolpopex


 

Dr. Rahul Mehan and Dr. Harpreet Wadhwa are proud to offer the latest technology for management of urologic disorders with robotics.

 

Maximum results, minimal incisions

Dr. Mehan and Dr. Wadhwa have been nationwide proctors of da VinciⓇ robotic surgery. They routinely participate in national and international events for robotic surgery, keeping with the latest technology in this rapidly expanding area of urology.

The classic treatment of cystocele or rectocele required large abdominal or vaginal incisions.

Newer treatment of cystocele and rectocele involve minimally invasive surgery. Dr. Mehan and Dr. Wadhwa are able to replicate the same procedure that is done with a large (open) incision with the latest technology. They are proud to offer da Vinci laparoscopic, robotic, and vaginal repair of pelvic prolapse issues.


What is da Vinci robotic surgery?

Simply put, the reason why we used to make large incisions for major surgeries was so we could put our hands inside the body. With the advent of robotics, we perform the same surgery, arguably better, with smaller incisions because instead of the surgeon’s hands, we only need to make a few small half-inch incisions to insert the robotic hands. From there, we use 3D vision, high-definition cameras, and the latest technology to translate the surgeon’s hand movements to the robotics. Think Wii for robotic surgeons!

All this technology translates to more precise movements, vision that is magnified in 3D, and other benefits. The result is our patients rarely require blood transfusions, have less pain and smaller incisions than open surgery, and return home in 24-48 hours.


Pre-procedure

It is critical that you stop any aspirin, CoumadinⓇ, PlavixⓇ, or other blood thinners one week before your procedure. Please call our office should you have any questions about this.

The day before your procedure, we ask that you take only a clear liquid diet (soups, broths, etc). However, no eating or drinking after midnight the night before surgery. Wear comfortable, loose-fitting clothing like a jogging suit on the day of your procedure. Bring a list of all the prescription and nonprescription medications that you take regularly with you on the day of the procedure.

You may also be requested to use a FleetⓇ enema the day before your procedure.

Please plan to arrive two hours prior to your treatment. The procedure usually takes three hours, and Dr. Mehan or Dr. Wadhwa will come and speak to your family afterward.

Upon awakening from the procedure, you will have a catheter draining your bladder. I have yet to meet a person who likes having a catheter, but relax, the catheter typically will remain for just one or two days and then be removed.

It is not unusual to have a sensation of wanting to urinate, or to have bladder spasms after surgery. This usually goes away within one to two days. If symptoms last longer, a temporary medication to stop bladder spasms may be required.


Procedure

Minimal incisions! That’s the good part. Da Vinci robotic cystocele/rectocele repair is performed with four tiny incisions, no wider than your thumb. Using the robot, Dr. Mehan or Dr. Wadhwa is able to repair and restore many of the sagging support structures of the pelvic organs. Mesh, similar to that used to fix hernias, has been shown to markedly improve the repair and reduce the chance of recurrent bladder or rectal prolapse.

For some women with more complex reconstructive issues, a combined robotic/vaginal approach may be required to achieve optimal results.


Post-procedure

After the procedure, although many patients may do fine with no problems, some patients may experience minor, temporary issues such as noticing burning with urination, or frequent urination. A Foley catheter draining the bladder is usually removed 24-48 hours after the procedure.


Advice after da Vinci robotic cystocele/rectocele repair

Definitely rest up for a week after the procedure. Drink at least six to eight glasses of water, and stay well hydrated.

For pain, Advil®, Motrin®, or prescription Toradol® work great, dependent upon your doctor’s advice. Never take a medication without clearing it with your doctor first. These are nonnarcotic, so you don’t get sleepy, constipated, or have other issues; however they are great anti-inflammatories. Take them on a regular basis the first two to three days after the procedure. For pain not relieved by these medications, use the prescription Tylenol® with codeine or Vicodin® that was prescribed for you.

Vaginal spotting may be common, and should gradually decrease after surgery. You should not have intercourse for six weeks after the procedure.


Bowels

Do not strain when having a bowel movement. Expect irregular bowel habits until fully recovered. Increase fiber in your diet with fruits, salads, etc. You may need a stool softener or laxative such as Metamucil®.

Do not take blood thinners or aspirin products for one week or as directed by your physician.


Activity

Take it easy for the first week after the procedure. Do not drive or operate dangerous equipment for one week. You may be able to resume nonstrenuous activities after one week unless otherwise directed by your physician. Avoid strenuous exercise, heavy lifting greater than 20 pounds, bike riding, and yard work for two weeks. Try to minimize excessive bending and squatting maneuvers.

After two weeks, you can gradually increase your workload until four to six weeks following surgery, at which time you can usually resume most activity. The main issue is to reduce chance of a hernia at your incision site, or a recurrence of your prolapse, so please use your common sense. If doing some activity is uncomfortable or hurts, don’t do it!


Diet and fluid

Stay well hydrated, drinking six to eight glasses of fluid a day. Eat healthy with lots of fruit, vegetables, and salads.


Expected signs and symptoms

You may experience bruising or swelling around the incision sites, especially around the navel area. This is normal and should subside in one to four weeks. After a few months all the inflammation and swelling will go away, and the incisions will slowly resemble a thin line and barely be visible.


Follow-up

Usually, Dr. Mehan, Dr. Wadhwa, or their staff will communicate to you a desired follow-up time frame. Please call us the day after the procedure to verify a time to see us in the office.


Long term

The majority of people will notice a substantial decrease or absence of pelvic pain with standing, urinating, or having bowel movements. Overactive bladder and incontinence are also improved, or are resolved completely.