Design: Case report

Setting: Patient was positioned in lithotomy position, patient safety was ensured

Patients or Participants: 63-year-old P2 who presented for evaluation of vaginal and rectal prolapse. She has a complicated history of anal cancer with resection causing significant sphincter injury and led to severe rectal prolapse and fecal incontinence. She had multiple rectal prolapse surgeries including perineal repair and ventral mesh rectopexy with no improvement. She also noted vaginal prolapse along with difficulty with bladder emptying. She had a history of a mesh sling, hysterectomy and “bladder lift.” Physical exam noted severe rectal prolapse and stage 2 vaginal prolapse.

Interventions: Single port access trocar was placed intra-abdominally through left mid rectus colostomy site and the SP robot was docked. Existing mesh was used to support the vaginal apex in a modified sacrocolpopexy. Permanent monofilament suture was used to attach the mesh to the vaginal apex and posterior vaginal wall. Using nonabsorbable barbed suture, modified closure of the enterocele was performed, utilizing the mesh along the right side, and the uterosacral ligament on the left. The mesh was completely retroperitonealized. The rectum and the sigmoid colon were then brought up to the abdomen on tension and distal colon was exteriorized. Loop colostomy was then matured. A perineal Thiersch stitch was placed around the anal canal.

Measurements and Main Results: Rectal and vaginal prolapse symptoms resolved immediately, with improvement in her bladder emptying symptoms as well.

Conclusion: Single port robotic pelvic reconstruction is feasible through colostomy access when this is applicable to the patient scenario avoiding the need for additional incisions. Multidisciplinary care may warrant discussion to consider the best approach for the patient's unique clinical presentation.