Pelvic floor reconstruction: state-of-the-art and beyond

Reconstructive surgery for pelvic-floor dysfunction is challenging and complex. It requires an extensive familiarity with pelvic anatomy and a wide armamentarium of surgical procedures to offer patients with various structural defects. Not every patient is suited for every procedure and the surgeon must be able to individualize the approach. Each technique has indications and benefits: vaginal repairs are relatively simple and cause less morbidity than abdominal repairs, which are generally more durable. Laparoscopic repairs provide excellent visualization with decreased morbidity, but operative times are longer, there is greater cost, and learning curves are steep. Techniques and principles described for vaginal and abdominal approaches can be applied to laparoscopic and robotic surgery, but comparative outcomes are not available. Robotic assistance with the laparoscopic approach may bring this method to the mainstream by helping surgeons who are not trained formally in laparoscopy to perform advanced skills. Advances in technology and surgical skills will support the application of laparoscopic and robotic approaches, and the development of better synthetic and biologic materials likely will improve vaginal repairs. Future studies will determine the utility of the approach.