Tommaso Simoncini1, Eleonora Russo2, Paolo Mannella2, Andrea Giannini2. 1. Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy. tommaso.simoncini@med.unipi.it. 2. Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Abstract
BACKGROUND: Abdominal sacral hystero-cervicopexy (ASC) is the gold standard for the treatment of apical prolapse, but requires advanced laparoscopic skills and exposes to potentially life-threatening complications. Lateral apical suspension to the abdominal wall with mesh is a feasible alternative of ASC where robotic assistance may offer specific advantages. We here describe the surgical technique and the short-term outcomes of robotic-assisted lateral apical suspension (R-ALS) with the use of a titan-covered T-shaped mesh. METHODS: Forty consecutive patients with stage III or IV symptomatic anterior and apical pelvic organ prolapse underwent R-ALS between September 2014 and September 2015. RESULTS: R-ALS was completed without complications in all cases with a mean operative time of 117 ± 26 min. From a technical standpoint, robotic assistance allowed for an extremely reproducible technique, with a swift learning curve and consistent length of the surgical steps. The procedure was extremely well tolerated and resulted in complete resolution of POP-associated symptoms and in improvements of POP- and incontinence-related quality-of-life scores (PQOL and IIQ7) at 1 month from surgery. CONCLUSIONS: R-ALS is feasible, safe, well-tolerated and effective at a short-term follow-up. R-ALS may represent an effective and simple alternative to abdominal sacral hystero-cervicopexy for the treatment of high-grade apical and anterior POP, avoiding the challenges of sacral mesh fixation. Robotic assistance helps achieving optimally tailored anatomic reconstruction, allowing seamless deep pelvic dissection and suturing.
BACKGROUND: Abdominal sacral hystero-cervicopexy (ASC) is the gold standard for the treatment of apical prolapse, but requires advanced laparoscopic skills and exposes to potentially life-threatening complications. Lateral apical suspension to the abdominal wall with mesh is a feasible alternative of ASC where robotic assistance may offer specific advantages. We here describe the surgical technique and the short-term outcomes of robotic-assisted lateral apical suspension (R-ALS) with the use of a titan-covered T-shaped mesh. METHODS: Forty consecutive patients with stage III or IV symptomatic anterior and apical pelvic organ prolapse underwent R-ALS between September 2014 and September 2015. RESULTS: R-ALS was completed without complications in all cases with a mean operative time of 117 ± 26 min. From a technical standpoint, robotic assistance allowed for an extremely reproducible technique, with a swift learning curve and consistent length of the surgical steps. The procedure was extremely well tolerated and resulted in complete resolution of POP-associated symptoms and in improvements of POP- and incontinence-related quality-of-life scores (PQOL and IIQ7) at 1 month from surgery. CONCLUSIONS: R-ALS is feasible, safe, well-tolerated and effective at a short-term follow-up. R-ALS may represent an effective and simple alternative to abdominal sacral hystero-cervicopexy for the treatment of high-grade apical and anterior POP, avoiding the challenges of sacral mesh fixation. Robotic assistance helps achieving optimally tailored anatomic reconstruction, allowing seamless deep pelvic dissection and suturing.
Entities:
Keywords:
Pelvic organ prolapse; Reconstructive surgery; Robotic surgery