Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse
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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.
Keywords
Open abdominal sacrocolpopexy Perioperative complications Robotic sacrocolpopexyNotes
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
Supplementary material
References
- 1.Lane FE (1962) Repair of posthysterectomy vaginal-vault prolapse. Obstet Gynecol 20:72–77PubMedCrossRefGoogle Scholar
- 2.Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014PubMedGoogle Scholar
- 3.Ostrzenski A (1996) Laparoscopic colposuspension for total vaginal prolapse. Int J Gynaecol Obstet 55(2):147–152PubMedGoogle Scholar
- 4.Di Marco DS, Chow GK, Gettman MT, Elliott DS (2004) Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology 63(2):373–376PubMedCrossRefGoogle Scholar
- 5.Advincula AP, Song A (2007) The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 19(4):331–336PubMedCrossRefGoogle Scholar
- 6.Parnell BA, Matthews CA (2011) Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery. Clin Obstet Gynecol 54(3):412–419PubMedCrossRefGoogle Scholar
- 7.Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112(6):1201–1206PubMedCrossRefGoogle Scholar
- 8.Siddiqui NY, Geller EJ, Visco AG (2012) Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol 206(5):435.e1–435.e5CrossRefGoogle Scholar
- 9.Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
- 10.Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P et al (2013) A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J 24(3):377–384PubMedCrossRefGoogle Scholar
- 11.Akl MN, Long JB, Giles DL, Cornella JL, Pettit PD, Chen AH et al (2009) Robotic-assisted sacrocolpopexy: technique and learning curve. Surg Endosc 23(10):2390–2394PubMedCrossRefGoogle Scholar
- 12.Mustafa S, Amit A, Filmar S, Deutsch M, Netzer I, Itskovitz-Eldor J et al (2012) Implementation of laparoscopic sacrocolpopexy: establishment of a learning curve and short-term outcomes. Arch Gynecol Obstet 286(4):983–988PubMedGoogle Scholar
- 13.Woelk JL, Casiano ER, Weaver AL, Gostout BS, Trabuco EC, Gebhart JB (2013) The learning curve of robotic hysterectomy. Obstet Gynecol 121(1):87–95PubMedGoogle Scholar
- 14.Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U (2008) What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 15(5):589–594PubMedGoogle Scholar
- 15.Bell MC, Torgerson JL, Kreaden U (2009) The first 100 da Vinci hysterectomies: an analysis of the learning curve for a single surgeon. S D Med 62(3):93–95Google Scholar
- 16.Yamamoto M, Minikel L, Zaritsky E (2011) Laparoscopic 5-mm trocar site herniation and literature review. JSLS 15(1):122–126PubMedCentralPubMedGoogle Scholar