Abstract
Introduction and hypothesis
Open abdominal sacrocolpopexy has been the preferred treatment for post-hysterectomy vaginal vault prolapse. In light of the rise in popularity of less invasive robotic sacrocolpopexy, our objective was to compare perioperative complications of robotic vs open sacrocolpopexy.
Methods
This was a single-institution, retrospective cohort study of robotic and open sacrocolpopexies. Robotic sacrocolpopexies performed between 1 January 2007 and 31 December 2009 were compared with open cases performed between 1 January 2002 and 31 December 2006. Baseline and intraoperative variables of the groups were compared. Complications were compared univariately and in a multivariable logistic regression model to adjust for prior transabdominal surgery.
Results
A total of 50 robotic and 87 open sacrocolpopexies were analyzed. Baseline characteristics were similar, but patients in the open group had more prior transabdominal surgeries. The robotically assisted group had decreased estimated blood loss (median, 100 mL vs 150 mL; P = 0.002) and hospital stay (median, 2 days vs 3 days; P < 0.001), but increased operative time (median, 4.6 vs 2.9 h; P < 0.001), cystotomy (10.0 % [5 out of 50] vs 1.1 % [1 out of 87]; P = 0.02), and vaginotomy (24.0 % [12 out of 50] vs 5.7 % [5 out of 87]; P = 0.003). Two patients in the robotically assisted group had postoperative hernia. There were no differences in rates of ureteral or bowel injury, urinary tract infection, ileus, bowel obstruction, or overall complications.
Conclusions
Overall complication rates of robotic and open sacrocolpopexy were not significantly different. The robotically assisted group experienced shorter hospital stay but increased operative times and increased incidence of cystotomy and vaginotomy, possibly reflecting the learning curve of robotic sacrocolpopexy.
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Funding
This project was supported by the Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA, and by grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH). The contents of this study are solely the responsibility of the authors and do not necessarily represent the official views of NCATS and the NIH.
Conflicts of interest
E.C. Trabuco: royalties—Elsevier, UpToDate
J.B. Gebhart: consultant—Ethicon Endo-Surgery Inc; Advisory Board—Astellas Pharma US Inc, Boston Scientific; royalties—Elsevier, UpToDate
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Anand, M., Woelk, J.L., Weaver, A.L. et al. Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse. Int Urogynecol J 25, 1193–1200 (2014). https://doi.org/10.1007/s00192-014-2379-9
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DOI: https://doi.org/10.1007/s00192-014-2379-9