Robotic-assisted sacrocolpopexy (RASC) in a renal transplant patient with Ehlers-Danlos syndrome (EDS), case report and literature review of perioperative considerations

With aging populations and advances of healthcare, patients with complex medical histories are more likely to present to our Urogynaecological practices. Similarly, with surgical advances, robotic-assisted surgery is currently gaining momentum with a view to improving surgical precision and potentially patient outcomes. Here, we present the first robotic-assisted sacrocolpopexy in a renal transplant patient with Ehlers-Danlos syndrome, and review the literature for perioperative considerations in these patients. Our 51 year old patient presented with obstructive micturition due to advanced pelvic organ prolapse (POP). A pre-operative diagnostic laparoscopy was performed to evaluate abdominal accessibility and aid decision regarding surgical approach for prolapse repair. An uncomplicated robotic assisted sacrocolpopexy was performed with uneventful postoperative recovery, no prolapse recurrence and improved quality of life at 1 year follow-up. When surgical repair is indicated in patients with POP after renal transplantation, in most cases vaginal approach will be chosen for primary surgery. Patients at high risk of recurrence of POP, such as the case described here, may benefit from abdominal approach. However, there is limited evidence on safety, feasibility and long-term outcomes following minimally-invasive abdominal POP repair in these cases. We conclude that robotic-assisted approach is feasible and could improve patient outcomes. However, more evidence needs to be generated to support such practice in high-risk patients. We call upon specialist societies to utilize surgical databases to support such cause.