Q&A with Duke urogynecologist Anthony Visco

The word prolapse means falling out of place. Prolapse of a woman’s pelvic floor organs -- vagina, uterus, bladder, or rectum -- can happen when tissues or muscles in the pelvis weaken.

Women with prolapse may feel pressure, pulling, or stretching anywhere from the groin to the lower back; they may also have a feeling of fullness or that something is falling out of them; some women also experience incontinence.

Most women consider prolapse, like incontinence, to be a private condition, and they just aren’t inclined to talk about it. But for some women, it has a drastic effect on their day-to-day lives, and Duke urogynecologist Anthony Visco, MD, wants these women to know that treatments are available and rapidly improving -- in fact, this condition is at the forefront of surgical technology.

Anthony Visco, MDVisco trained at Duke, where the gold standard surgical treatment for prolapse was developed: colpopexy, a procedure in which the vagina is moved back into place and held there with a soft mesh. Colpopexy can cure the condition, but until recently it required a long abdominal incision.

Now there’s a robot on the scene -- the da Vinci system, which uses only five small incisions to do its work.

Visco is one of a growing number of Duke surgeons using the da Vinci system for gynecologic procedures, and in terms of robotic colpopexy, he literally wrote the book: He authored the procedure guide and video for the surgery. Because Visco has performed more robotic colpopexies than any other surgeon, he regularly holds courses at Duke to teach colleagues from across the globe.

HealthLine asked our world expert to help us understand this new approach to pelvic floor prolapse:

What misconception would you like to clear up about prolapse?

I’d like to dispel the idea that prolapse is only an older person’s problem. It can happen at any age, and it results from a variety of things -- childbirth, chronic coughing or straining, or the aging process. It can develop gradually, often over many years, or abruptly. I also think it’s important for women to know that treatments for prolapse are available -- they don’t have to “just live with it.”

Are there nonsurgical ways to treat prolapse?

Yes. Prolapse can be managed by using pessaries -- devices that are placed in the vagina to hold everything in place. A pessary will often work well for a woman, but it’s important to remember that it won’t make the condition go away.

Surgical procedures, on the other hand, will fix the condition. Why should women consider robotic surgery instead of a traditional, open procedure? My opinion is that robotic surgery gives women a gold standard repair with a minimally invasive approach.

Colpopexy has the lowest rate of recurrence, and the robotic approach allows women to recover quickly, with a low risk of complications. Though the surgeon is operating through tiny incisions, the da Vinci machine allows him or her a very high level of dexterity.

Is the surgery dangerous?

Every surgery has some risk, but robotic colpopexy is much less invasive than traditional surgeries. The incidence of complications is very low, and there is so little blood loss that we measure it in tablespoons. Most women go home the morning after the procedure.

Gynecologic Robotics at Duke: High Tech with a Gentle Touch

The da Vinci system may at first seem too futuristic to believe. Its four robotic arms are directed entirely by the surgeon from several feet away, through sensitive controllers and a 3-D visual console.

This technology makes the da Vinci machine a unique blend of precision and finesse: Through only a few tiny incisions, it allows the surgeon to see almost as well as if he or she were looking inside you. The robotic arms match the surgeon’s movements exactly -- mimicking not only his hands but also his wrist movements, on a microsurgical scale. The da Vinci system is also used by several Duke gynecologic surgeons for prolapse repair, hysterectomies, fibroid removal, fertility procedures, and treatment of female cancers.

The men have a stake in it too -- many Duke urologists use the da Vinci machine for prostate cancer surgeries.