Elizabeth J Geller1, Nazema Y Siddiqui, Jennifer M Wu, Anthony G Visco. 1. From the Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Duke University, Durham, North Carolina.
Abstract
OBJECTIVE: To compare short-term outcomes of robotic sacrocolpopexy with abdominal sacrocolpopexy for vaginal vault prolapse. METHODS: We conducted a retrospective cohort study comparing robotic to abdominal sacrocolpopexy with placement of permanent mesh. The primary outcome was vaginal vault support on 6-week postoperative pelvic organ prolapse quantification (POP-Q) system examination. Secondary outcomes included blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, postoperative fever, pneumonia, wound infection, and urinary retention. RESULTS: The analysis included 178 patients (73 robotic and 105 abdominal sacrocolpopexy). There were no differences in age, race, or body mass index. Robotic sacrocolpopexy showed slight improvement on POP-Q "C" point (-9 compared with -8, P=.008) when compared with abdominal sacrocolpopexy and was associated with less blood loss (103+/-96 mL compared with 255+/-155 mL, P<.001), longer total operative time (328+/-55 minutes compared with 225+/-61 minutes, P<.001), shorter length of stay (1.3+/-0.8 days compared with 2.7+/-1.4 days, P<.001), and a higher incidence of postoperative fever (4.1% compared with 0.0%, P=.04). There were no differences in other secondary outcomes. Operative time remained significantly greater in the robotic group (P<.001), and estimated blood loss remained lower (P<.001) when controlling for possible confounders. CONCLUSION: Robotic sacrocolpopexy demonstrated similar short-term vaginal vault support compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and shorter length of stay. Long-term data are needed to assess the durability of this new minimally invasive procedure. LEVEL OF EVIDENCE: II.
OBJECTIVE: To compare short-term outcomes of robotic sacrocolpopexy with abdominal sacrocolpopexy for vaginal vault prolapse. METHODS: We conducted a retrospective cohort study comparing robotic to abdominal sacrocolpopexy with placement of permanent mesh. The primary outcome was vaginal vault support on 6-week postoperative pelvic organ prolapse quantification (POP-Q) system examination. Secondary outcomes included blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, postoperative fever, pneumonia, wound infection, and urinary retention. RESULTS: The analysis included 178 patients (73 robotic and 105 abdominal sacrocolpopexy). There were no differences in age, race, or body mass index. Robotic sacrocolpopexy showed slight improvement on POP-Q "C" point (-9 compared with -8, P=.008) when compared with abdominal sacrocolpopexy and was associated with less blood loss (103+/-96 mL compared with 255+/-155 mL, P<.001), longer total operative time (328+/-55 minutes compared with 225+/-61 minutes, P<.001), shorter length of stay (1.3+/-0.8 days compared with 2.7+/-1.4 days, P<.001), and a higher incidence of postoperative fever (4.1% compared with 0.0%, P=.04). There were no differences in other secondary outcomes. Operative time remained significantly greater in the robotic group (P<.001), and estimated blood loss remained lower (P<.001) when controlling for possible confounders. CONCLUSION: Robotic sacrocolpopexy demonstrated similar short-term vaginal vault support compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and shorter length of stay. Long-term data are needed to assess the durability of this new minimally invasive procedure. LEVEL OF EVIDENCE: II.
Authors: Gregory P McLennan; Larry T Sirls; Kim A Killinger; Dmitriy Nikolavsky; Judith A Boura; Melissa C Fischer; Kenneth M Peters Journal: Int Urogynecol J Date: 2012-06-06 Impact factor: 2.894