Single site robotic-assisted apical lateral suspension (SS R-ALS) for advanced pelvic organ prolapse: first case reported

While single-port laparoscopy for gynecological surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present the first case of single-incision, robotic apical lateral suspension (R-ALS) using this device in pelvic organ prolapse (POP) surgery. A 71-year-old female with advanced symptomatic anterior and apical prolapse (POP-Q stage III/III) was operated with a single-site approach using the Da Vinci Single-Site® robotic surgery device. After docking the robot, the complete surgery was performed by robotic approach; only abdominal sub-peritoneal passages of the lateral arms of the mesh were performed extra-corporeally as described in the canonical surgical technique of R-ALS. The procedure was successfully completed in 155 min. No surgical complications occurred during the intervention and the postoperative stay and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of R-ALS using the Da Vinci Single-Site robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are reduced instrument clashes and less surgical scars for the patient. Restoration of triangulation and the lack of monopolar scissors are still limits which are partially overcome by the degrees of freedom of robotic instruments.