Incontinence and Pelvic Organ Prolapse Surgery

Since the Food and Drug Administration (FDA), USA granted its approval to use the da Vinci Robotic Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for gynecological practice, it has been documented that the advantages of robotics apply well to urogynecologic procedures. The two most common operative techniques in this area are Burch’s procedure for stress urinary incontinence and sacrocolpopexy for correct the pelvic organs prolapse. During both procedures, complications can arise. The most common in retropubic cystourethropexy are injuries to the urinary organs during dissection and suture fixation; vascular damage, ureteral entrapment, and obturator nerve damage can occur, furthermore others less frequent that have been reported. Regarding to sacrocolpopexy, vascular injuries to promontory and iliac vessels may occur, mesh erosion and migration is an important issue and rarely but osteomyelitis can befall. It is mandatory to understand the anatomy of the Retzius and presacral spaces to avoid the mentioned complications, as well to be prepared to control and repair of the injuries in these procedures, with patience and efficiency. Proved skills in laparoscopic and robotic suturing is mandatory for the appropriate performance of urogynecologic procedures. In this chapter, the complications reported and how to resolve them are described.