‘Cupid and Psyche’: A Novel Technique for Robotic Hysterosacropexy in the Treatment of Pelvic Organ Prolapse

Purpose

The purpose of any surgical repair of pelvic organ prolapse (POP) is to restore pelvic anatomy, preserving urinary, intestinal and sexual functions while avoiding complications. We present a novel robotic approach to hysterosacropexy (HSP) in the treatment of POP.

Methods

In our technique (named ‘Cupid and Psyche’, recalling as it does the famous sculpture by Canova), the two branches of the MESH encircle the uterus from behind, lifting and supporting it.

The aim of this technique is to resolve POP, minimizing the risk of vaginal erosion: the posterior ‘embrace’ of the uterus limits the direct contact of the mesh with the vagina, thus reducing any risk of erosion/extrusion at this level. We performed 10 cases of robotic HSP.

Results

All procedures are completed robotically. Median operative time (skin-to-skin) is 125 min [interquartile range (IQR) 85-145], including port placement, robot docking and console time. We have never had any cases of intraoperative or postoperative complications.

With regard to short-term follow-up, analysis of outcomes is limited; in any case, we have never had any cases of MESH erosion or other complications, and no sexually active woman complained of dyspareunia.

Conclusions

Maintaining sufficient motility of the vagina is another advantage of ‘Cupid and Psyche’, avoiding as it does any negative effects on patients’ later sexual activity, granting more natural motility of both uterus and vagina but resolving the prolapse.

Further prospective studies comparing the long-term functional outcomes of the various HSP techniques are needed to confirm these findings.