Minimally Invasive Robotic Laser Surgery for Incontinence
By Marja Sprock, M.D.

The medical technology advances rapidly. Great strides have been made in changing big abdominal surgeries to laparoscopic or robotic surgeries. The advantage is smaller scars, quicker recovery time.

Natural orifice surgery is another minimally invasive route. What it tries to accomplish is using natural openings like a mouth or vagina to perform surgery.

As a doctor in female pelvic medicine and reconstructive surgery, I will leave the access through the mouth to the real adventurers and will use the vagina as an access route, to perform surgery where scars can be nicely hidden. Recovery is also usually very fast.

DID YOU KNOW THAT: Robotic surgery leaves bigger scars than surgery by the laparoscope Robotic scars are around the navel and difficult to hide when trying to wear a two piece Most women who have undergone successful prolapse surgery wished they had done it a lot sooner Botox can be used in the bladder to help against bladder spasms and is covered by a lot of insurances Urinary and fecal incontinence can often be helped or cured by training the muscles of the pelvis Pelvic muscle training can be achieved by everybody, biofeedback works great A hysterectomy is usually not needed/recommended to achieve repair of a prolapse if done vaginally Prolapse repair with the robot or laparoscope can usually leave the cervix intact Excessive water drinking is not healthier and can lead to urinary retention and incontinence Retention is only good in a pond

Using the vagina to perform surgery will not need the robot and for incontinence surgery the laser is not helpful either. Neither of the two will make the vaginal access, minimally invasive surgery any better or faster.

If you are bothered by incontinence with coughing, sneezing, laughing, working out, walking around, lifting up the (grand) kids, you may have what is called stress incontinence. The first line of treatment should focus on your pelvic floor muscles. These muscles are often referred to as your Kegel muscles.

One of the most often heard comments are:” I tried the Kegels and they do not work”. This may be true and it may not be enough to cure your stress urinary incontinence, but other women have practiced by contracting every muscle in their body except the pelvic floor muscles. Biofeedback, where the contraction strength can be seen on a monitor, can be taught quickly to most women with excellent result.

As with any muscle you train hard to make strong you have to keep on exercising the muscle. For your pelvic floor muscles you do not have to go to the health club though and can train them almost anywhere.

If your pelvic floor muscles are up to par and you still have bothersome stress leakage and need to wear a panty liner or pad, you may want to consider a minimally invasive surgery that uses the natural orifice of your vagina as access. It leaves no visible scars. It is mostly performed as a quick outpatient surgery, but can even be done in the office. Obviously some anesthesia will be provided.

Success rates are between 85-90% and you may want to recuperate the day after to get the entire anesthesia out of your body, but then you are back to activity. I would not start with lifting heavy weights and give the sling some time to heal. Since the surgery is performed through the natural orifice called a vagina and has about two stitches, intercourse will have to wait for about six weeks.

The sling (pictured at the left) is made of open weave polypropylene, a naturally quite inert material and your own tissue will mostly incorporate it.

The surgery will take about 5 to 10 minutes, and the result may be life altering. Maybe the natural orifice surgery is too easy and we should convert the surgery to a minimally invasive robotic laser surgery.

Thinking about it ... guess not really an improvement over what we already have.

If you like more information about biofeedback or the minisling for stress urinary incontinence, please call for an appointment at 321-806-3929, send us a note or visit us online at www.CFUroGyn.com.  Dr. Sprock is affiliated with Central Florida UroGynecology in Rockledge.