Da vinci sacrohysteropexy

Da Vinci sacrohysteropexy in Turkey: what it is and how it works

Da Vinci sacrohysteropexy is a robot-assisted operation to treat uterine prolapse, a condition in which the womb slips down into or out of the vagina because the pelvic supports have weakened. Instead of removing the uterus, the surgeon lifts it back to its normal position and fixes it to the sacral promontory, a bony point at the base of the spine, using a strip of synthetic mesh. The surgeon controls the da Vinci system from a console and works through four or five small keyhole incisions in the abdomen. Because the womb is kept, the operation is attractive to women who want to avoid a hysterectomy, for example those who still hope to conceive or who simply prefer to keep their uterus.

This guide explains how sacrohysteropexy works, what the evidence says about it and about mesh, how it compares with other prolapse treatments, what it costs in Turkey compared with the UK, US and Germany, what recovery involves and how to check a hospital. It is general information, not medical advice. For other conditions treated by this speciality see our gynaecology treatments in Turkey overview.

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What are the symptoms of uterine prolapse, and when is surgery considered?

Prolapse often feels like heaviness or dragging in the pelvis, a bulge in the vagina, a sensation of sitting on a ball, difficulty emptying the bladder or bowel, urinary leakage or discomfort during sex. It is graded from mild to severe, and mild cases may need only pelvic floor physiotherapy, weight management or a vaginal support ring (pessary). Surgery is usually considered when symptoms trouble you, when a pessary has not worked or is not wanted, or when the womb is descending outside the vaginal opening. A gynaecologist will examine you, often grade the prolapse and check the bladder and bowel before recommending an operation.

How is robotic sacrohysteropexy performed step by step?

The operation is done under general anaesthesia and usually takes between two and four hours. Gas is introduced into the abdomen, the robotic arms are docked and the surgeon frees the uterus and the tissues in front and behind the cervix. A mesh is attached to the cervix or the back of the uterus and then fixed with sutures to the ligament in front of the sacrum, so that the womb is held up at the top of the vagina without tension. The mesh is covered with the peritoneum, the lining of the abdomen, to keep it away from the bowel. If the bladder or bowel also bulge into the vagina, the surgeon may add a repair of those walls, and a stress incontinence procedure is sometimes combined with it. The robotic wrist-like instruments and 3D view help with the stitching in the deep pelvis, where the angle is difficult with straight keyhole instruments.

Does sacrohysteropexy work, and what about the mesh?

Studies of abdominal (keyhole or robotic) uterus-sparing mesh repair report good support and symptom improvement in most women, with a lower rate of the prolapse returning at the top of the vagina than many vaginal operations, although some women need a further operation later. Robotic and standard laparoscopic approaches give similar results, with the robot adding cost; the main advantage is for surgeons with robotic training and complex pelvic anatomy.

Mesh needs honest discussion. The safety concerns that led to restrictions in the UK and elsewhere related mainly to mesh placed through the vagina. Mesh attached to the sacrum through the abdomen is regarded differently, but mesh complications such as exposure through the vaginal wall, pain or infection can still occur. Women should be told the type of mesh, why it is used and what the alternatives are, and your gynaecologist should record your informed consent. Regulators and societies including the NHS, NICE and the American Urogynecologic Society advise discussing mesh and non-mesh options before choosing.

Sacrohysteropexy, hysterectomy, vaginal repair or pessary?

The choice depends on your age, plans for pregnancy, the grade of prolapse, other pelvic problems and your preference. A hysterectomy removes the uterus and can be combined with a vault fixation; see our pages on hysterectomy, laparoscopic hysterectomy and robotic hysterectomy with the da Vinci system.

Who is a candidate for sacrohysteropexy, and who is not?

Suitable candidates are women with symptomatic uterine prolapse who want to keep the uterus, have a healthy cervix with up-to-date screening results and are fit for general anaesthesia and a long operation. It may not suit women with abnormal bleeding, fibroids or other uterine disease where removal is advisable, an active infection, a history of problems with mesh, severe obesity that makes keyhole access difficult, or women who are pregnant. If you plan another pregnancy, tell the surgeon, because pregnancy after the repair carries special considerations and a caesarean birth is commonly advised. Smoking and chronic cough or constipation raise the chance of recurrence, so these should be addressed.

Da Vinci sacrohysteropexy cost and price in Turkey

The figures below are approximate ranges for the operation including the hospital stay, not hospital quotes. Each hospital confirms its own price in writing after your gynaecologist reviews your examination, scans and history.

The price changes with the operating time, the type of mesh, whether extra repairs of the bladder or bowel walls are added, the nights spent in hospital and the surgeon. Ask whether the package includes the pre-operative tests, the anaesthetist, the single-use robotic instruments, the mesh, two to three hospital nights, medicines, transfers and a follow-up check, and who treats you and pays if a complication needs further care.

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How long is the recovery after robotic prolapse surgery?

Most women spend two to three nights in hospital and about five to seven days in Turkey in total, so that the surgeon can check the wounds, the bladder and the bowel before you fly. Expect soreness, shoulder-tip pain from the gas and light vaginal bleeding or discharge for a few weeks. Walk daily from the first day, and avoid constipation and straining with a high-fibre diet and the laxatives you are given. Many women return to desk work after two to three weeks, to driving when they can brake comfortably, and to light exercise after four to six weeks.

The new support needs time to scar into place, so avoid heavy lifting, high-impact exercise and sexual intercourse for roughly six to twelve weeks, or as the surgeon advises. Short flights are usually acceptable once cleared; keep moving and drink water to reduce clot risk. Pelvic floor exercises after the early weeks help the result last.

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What are the risks and complications?

Every operation carries risk. General risks include bleeding, infection, blood clots and anaesthetic problems. Specific risks of sacrohysteropexy include injury to the bladder, bowel, ureter or blood vessels near the sacrum, mesh exposure or erosion, pelvic or back pain, new bladder or bowel symptoms, problems with sex, a return of the prolapse and, rarely, bowel obstruction or infection of the spine near the fixation point (discitis). Some women need a further operation to treat the prolapse again or to deal with a mesh problem. Ask the surgeon how often these occur in the hospital's own practice and what the plan is if they do. Seek urgent help for fever, severe pain, heavy bleeding, an inability to pass urine or a swollen, hot leg.

How do you choose a hospital for robotic gynaecological surgery, and what are the red flags?

Look for a gynaecologist or urogynaecologist who performs pelvic floor surgery regularly, a hospital with intensive care and a clear consent process that explains mesh, and a plan for follow-up at home. Red flags are a quote without a proper examination, no discussion of non-mesh options or a pessary, pressure to choose the robot, promises that prolapse will never return and no named surgeon. Read how our process works and send your history, previous operations and any scans through the free quote page so a hospital can review you before anything is booked.

Questions to ask the clinic

• Is sacrohysteropexy right for my grade of prolapse, and what are the non-mesh alternatives?
• What mesh will be used, and how often does your team see mesh problems?
• Can I become pregnant afterwards, and how would I deliver?
• How many robotic prolapse repairs does my surgeon perform each year?
• What is included in the package, and how long will I need to stay in Turkey?
• Who follows me after I fly home, and who treats a complication?

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Conditions treated with Da Vinci Sacrohysteropexy

Hospitals with Gynaecology in Turkey

Academic Hospital

Üsküdar, Istanbul

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Lokman Hekim Istanbul Hospital

Pendik, Istanbul

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