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Contact & Location Details

Telephone: 9344 5099
Facsimile: 9344 5299
Call Service: 9387 1000
Email: office@drmarcuscarey.com

Main rooms and addresses for all correspondence and appointments:

Suite B, Level 2, Frances Perry House Consulting Suites (located in the Women's Hospital)

20 Flemington Road, Parkville, Victoria 3052

Dr Marcus Carey

Dr Marcus Carey is a Urogynaecologist working in both public and private practice in Melbourne. He is a Consultant Urogynaecologist at the Women's Hospital in Parkville, Melbourne. Dr Carey's private practice is located at Frances Perry Private Hospital located in the Women's Hospital, Parkville. He also operates at the Epworth Freemason's Hospital in East Melbourne.
Direct:
(03) 93445099
office@drmarcuscarey.com

Karen

Karen is Dr Carey's medical secretary.
Direct:
(03) 93445099
office@drmarcuscarey.com

Hayley

Hayley is Dr Carey's medical secretary. Hayley is also a registered nurse.
Direct: (03) 93445099
office@drmarcuscarey.com

The da Vinci Robotic Surgery System

Treatments

 / 

Robotic Surgery

Robotically Assisted Prolapse Surgery
Overview

The use of the da Vinci robot to assist prolapse surgery has grown rapidly in recent years. The da Vinci robot is now extensively used in the United States to assist surgeons in performing operations for prolapse. The two commonly performed prolapse operations using the da Vinci robot are the sacral colpopexy and sacral hysteropexy procedures. 

It is now estimated that 40% of sacral colpopexy operations for prolapse in the US are performed with the assistance of the da Vinci robot (approximately 25,000 cases a year).  Dr Carey uses the da Vinci robot for women who have advanced prolapse and wish to conserve their uterus (i.e. for women wishing to avoid a hysterectomy). Dr Carey also uses the robot for women with prolapse who have already had a hysterectomy (usually referred to as vaginal vault prolapse).

Advantages Of Robot Assisted Surgery

When performing robot assisted surgery the surgeon remains in complete control of the robotic instruments. Robot assisted surgery has important advantages for the surgeon and the patient over traditional laparoscopic and open abdominal surgery. Robot assisted surgery provides the surgeon with superior vision and surgical precision. 

When using the robot the surgeon has an operating field that is 10 times magnified along with three-dimensional depth of field vision (traditional laparoscopy provides only two-dimensional vision and six times magnification). The delicate articulating surgical instruments used in robot assisted surgery allow for more precise surgical dissection and more dextrous surgical manoeuvres when compared to traditional laparoscopic surgery.

Robot Assisted Sacral Colpopexy And Sacral Hysteropexy

The sacral colpopexy operation is often referred to as the ‘gold standard’ operation for prolapse because of the high long-term success rates associated with this surgery. This operation was first performed in 1957 through an abdominal incision. Since 1991 this surgery has been performed using laparoscopy (key-hole surgery) and since 2004 it has been performed with robotic assistance using the da Vinci robot.

Robot assisted sacral colpopexy is an operation that suspends the vaginal apex, using a synthetic graft, from a ligament on front of the sacrum (tail bone). This provides support for the upper part of the vagina (vaginal vault). A repair inside the vagina may also be required at the same time. This operation can be performed in combination with other procedures such as surgery for urinary incontinence.

How Is The Surgery Performed?

The surgery is performed under general anaesthesia (you are completely asleep). The operation is performed using the da Vinci robotic system (key-hole surgery). The uterus is suspended with a synthetic graft from a ligament on the front of the sacrum (tail bone). 

In some cases sutures rather than a synthetic graft are used. This provides very strong support for the uterus. A surgical repair inside the vagina may also be required, depending on the type of prolapse you have. At the end of the operation, a catheter will be inserted into the bladder to drain urine. This will remain in place over night. 

A cystoscopy (looking inside the bladder with a telescope) will usually be performed at the end of the surgery to check that no damage has occurred to the bladder or ureters (the tubes running from the kidneys down to the bladder).

Robot Assisted Sub-Hysterectomy And Total Hysterectomy

Some women with prolapse require a sub-hysterectomy (partial removal of the uterus) or total hysterectomy as part of their surgical treatment. Usually this is only required if there is a moderate or marked prolapse of the uterus. This surgery is performed with a sacral colpopexy procedure and can be carried out with robotic assistance. 

If a hysterectomy is required Dr Carey usually recommends a subtotal hysterectomy in order to preserve the cervix and ovaries, and to avoid making an incision at the vaginal apex. Usually the ovaries and fallopian tubes are not removed during hysterectomy for prolapse. The ovaries and fallopian tubes will be removed during the hysterectomy only if there is a specific reason (e.g. a family history of ovarian cancer).

Surgical Vaginal Support (SVS)

For some women having their prolapse repaired, Dr Carey may recommend placing a surgical vaginal support (SVS) into the vaginal at the completion of surgery. The use of a surgical vaginal support (SVS) is a new approach to surgery. The purpose of the SVS, which remains in the vagina for 3 to 4 weeks following surgery, is to provide extra support for the vagina during the healing period. 

Dr Carey or a nurse will remove the SVS during the post-operative check-up 3 to 4 weeks following surgery. Removal of the SVS is usually not uncomfortable. The SVS may cause a discharge from the vagina approximately 2 weeks after surgery. This discharge will disappear after the SVS is removed. The SVS may move down slightly after 3 weeks. If you feel the SVS has moved down you may gently push it up to a more comfortable position. If the SVS is causing significant discomfort or concern you should contact Dr Carey’s rooms or the nursing staff on ward 1 West at the Epworth Freemasons Hospital for advice.

What is a Synthetic Graft?

Synthetic graft (often referred to as mesh) is an inert material specifically designed for increasing wound strength and is permanent.

Synthetic grafts have been extensively used in surgery, especially in hernia repairs.

The synthetic graft provides a framework of support. The synthetic graft has many holes within it to allow the body's own tissue to grow into the synthetic graft.

Possible Complications Of Robot Assisted Prolapse Surgery

There are general risks involved with having an operation, including the anaesthetic, bleeding and blood transfusion, infection within the pelvis or wound and clots in the legs that can travel to the lungs. Antibiotic are given during surgery and continued after your operation to reduce the risk of infection. Medication (e.g. Fragmin or Clexane) to thin your blood is given during surgery and while you are in hospital to reduce your risk of developing blood clots. It is very uncommon to experience serious bleeding or need a blood transfusion or further surgery to control bleeding.

Generally there is improved sexual function after prolapse surgery. However, if vaginal surgery is also performed in addition to the robot assisted surgery about 2% of women may experience painful intercourse after surgery and this may require minor corrective surgery or the use of vaginal dilators.  

Whenever synthetic graft is used, there is a small risk of a small portion of the synthetic graft becoming exposed the vagina. This is usually treated with vaginal oestrogen cream or pessaries if the vaginal skin is thin or a small vaginal operation to remove the small amount of exposed synthetic graft (the entire graft will not need to be removed). The risk of synthetic graft exposure is much lower when used in robotic assisted prolapse surgery compared to vaginal prolapse surgery. Synthetic graft exposure or erosion into nearby organs such as bladder or bowel is extremely rare.

Occasionally bladder problems can occur after surgery (e.g. difficulty with bladder emptying, cystitis or urinary leakage). These problems usually settle soon after surgery. 

However, if incontinence remains a problem then a small operation or medication may be required. Pain may occur immediately after surgery but this generally settles after a few days or weeks. It is rare for women to experience long-term pain following prolapse surgery. Rare complications from prolapse surgery include injury to a nearby structure (e.g. bowel, bladder, ureter, nerve). 

Dr Carey may inspect the bladder with a telescope (cystoscopy) at the completion of surgery to exclude any bladder or ureter injury. Long-term rare complications after prolapse surgery include bowel obstruction from adhesions and abdominal hernia (weakening and bulging of the robotic incisions). Further surgery may be necessary if a complication occurs.

Figure 1 below demonstrates the vagina suspended from the sacrum with synthetic graft (sacral colpopexy). A surgical vaginal support device is placed into the vagina at the end of end of surgery and is removed 21 to 28 days after surgery.

Figure 2 below demonstrates the uterus suspended from the sacrum by a synthetic graft. A surgical vaginal support device is placed into the vagina at the end of end of surgery and is removed 21 to 28 days after surgery.