Advertisement

Robot-assisted laparoscopic sacrocolpopexy with autologous fascia lata: technique and initial outcomes

  • Victoria C. S. ScottEmail author
  • Janine L. Oliver
  • Shlomo Raz
  • Ja-Hong Kim
Original Article
  • 9 Downloads

Abstract

Introduction and hypothesis

Pelvic reconstructive surgery is increasingly being performed with autologous grafts to avoid complications of synthetic mesh and improve the durability of a native tissue repair. Autologous fascia lata (AFL) provides a reliable source of robust connective tissue to improve surgical outcomes. We present our technique and initial experience with performing robotic sacrocolpopexy (RSC) augmented with AFL.

Methods

A retrospective review was conducted of patients who underwent RSC with AFL between January 2015 and November 2017. Outcomes evaluated include recurrence of prolapse on physical examination, prolapse symptoms, urinary incontinence, patient satisfaction based on the Patient Global Impression of Improvement (PGI-I) and complications.

Results

Twelve patients were identified with a median age of 68 years (range, 46–77 years) at the time of RSC with AFL. Eleven patients had a history of prior sling and/or vaginal mesh. The median operative time was 225 min (177–302 min). There were no intra- or postoperative complications. After a median follow-up of 14.7 months (5.7 to 39 months), the median PGI-I response was 2 (range, 1–3, very much to a little better). No recurrent or persistent apical prolapse was observed. Three patients (25%) reported recurrence of sensation of a vaginal bulge, which were all due to anterior vaginal wall prolapse.

Conclusions

RSC can be performed with AFL and should be considered in patients with a history of mesh complications. Overall patient satisfaction was high. While these short-term outcomes are encouraging, further studies are needed to assess long-term durability of anatomic results.

Keywords

Robot-assisted laparoscopic sacrocolpopexy Fascia lata 

Abbreviations

ASC

abdominal sacrocolpopexy

AFL

autologous fascia lata

FL

fascia lata

PGI-I

Patient Global Impression of Improvement

POP

pelvic organ prolapse

RSC

robotic-assisted laparoscopic sacrocolpopexy

SUI

stress urinary incontinence

Notes

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Dunn GE, Hansen BL, Egger MJ, Nygaard I, Sanchez-Birkhead AC, Ana C, et al. Changed women: the long-term impact of vaginal mesh complications. Female Pelvic Med Recons Surg. 2014;20(3):131–6.CrossRefGoogle Scholar
  2. 2.
    Lee D, Zimmern PE. Management of complications of mesh surgery. Curr Opin Urol. 2015;25(4):284–91.Google Scholar
  3. 3.
    Cardenas-Trowers OO, Malekzadeh P, Nix DE, Hatch KD. Vaginal mesh removal outcomes: eight years of experience at an academic hospital. Female Pelvic Med Recons Surg. 2017;23(6):382–6.CrossRefGoogle Scholar
  4. 4.
    Rawlings T, Lavelle RS, Burhan C, Alhalabu F, Zimmern PE. Prolapse recurrence after transvaginal mesh removal. J Urol. 2015;194(5):1342–7.CrossRefGoogle Scholar
  5. 5.
    Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J Urol. 2017;198(4):875–83.CrossRefGoogle Scholar
  6. 6.
    Cundiff GW, Varner E, Visco AG, Zyczynski HM, Nager CW, Norton PA, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5.CrossRefGoogle Scholar
  7. 7.
    Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.CrossRefGoogle Scholar
  8. 8.
    McCoy O, Vaughan T, Nickles SW, Ashley M, MacLachlan LS, Ginsberg D, et al. Outcomes of autologous fascia Pubovaginal sling for patients with transvaginal mesh related complications requiring mesh removal. J Urol. 2016;196(2):484–9.CrossRefGoogle Scholar
  9. 9.
    Shah K, Nikolavsky D. Gilsdorf, Flynn BJ. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia. Int Urogynecol J. 2013;24(12):2111–7.CrossRefGoogle Scholar
  10. 10.
    Oliver JL, Chaudhry ZQ, Medendorp AR, Wood LN, Baxter ZC, Kim J, et al. Complete excision of sacrocolpopexy mesh with autologous fascia sacrocolpopexy. Urology. 2017;106:65–9.CrossRefGoogle Scholar
  11. 11.
    Lee U, Raz S. Emerging concepts for pelvic organ prolapse surgery: what is cure? Curr Urol Rep. 2011;12(1):62–7.CrossRefGoogle Scholar
  12. 12.
    Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Moarjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079.Google Scholar
  13. 13.
    Serati M, Bogani G, Sorice P, Braga A. Torella M, Salvatore S, et al. Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol 2014;66(2): 303–318.Google Scholar
  14. 14.
    Hudson CO, Northington GM, Lyles RH, Karp DR. Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis. Female Pelvic Med Recons Surg. 2014;20(5):252–60.CrossRefGoogle Scholar
  15. 15.
    Dahlgren E, Kjölhede P. Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study. Acta Obstet Gynecol Scand. 2011;90(12):1393–401.CrossRefGoogle Scholar
  16. 16.
    Linder BJ, Chow GK, Elliott DS. Long-term quality of life outcomes and retreatment rates after robotic sacrocolpopexy. Int J Urol. 2015;22(12):1155–8.CrossRefGoogle Scholar
  17. 17.
    Jong K, Klein T, Zimmern PE. Long-term outcomes of robotic mesh sacrocolpopexy. J Robot Surg. 2018;12:455–60.CrossRefGoogle Scholar
  18. 18.
    Anger JA, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman AR, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5–12.CrossRefGoogle Scholar
  19. 19.
    Sung HH, Ko KJ, Suh YS, Ryu GH, Lee K. Surgical outcomes and safety of robotic sacrocolpopexy in women with apical pelvic organ prolapse. Int Neurourol J. 2017;21(1):68–74.CrossRefGoogle Scholar
  20. 20.
    Pellegrino A, Damiani GR, Villa M, Sportelli C, Pezzota MG. Robotic sacrocolpopexy for posthysterectomy vaginal vault prolapse: a case series of 31 patients by a single surgeon with a long-term follow-up. Minerva Ginecol. 2017;69(1):13–7.Google Scholar
  21. 21.
    Tan-Kim J, Menefee SA, Lippmann Q, Lukacz ES, Luber KM, Nager CW, et al. A pilot study comparing anatomic failure after sacrocolpopexy with absorbable or permanent sutures for vaginal mesh attachment. Perman J. 2014;18(4):40–4.Google Scholar
  22. 22.
    Balgobin S, Fitzwater JL, McIntire DD, Delgado IJ, Wai CY. Effect of mesh width on apical support after sacrocolpopexy. Int Urogynecol J. 2017;28(8):1153–8.CrossRefGoogle Scholar
  23. 23.
    Tate SB, Blackwell L, Lorenz DJ, Steptoe MM, Culligan PJ. Randomized trial of fascia lata and polypropylene mesh for abdominal sacrocolpopexy: 5-year follow-up. Int Urogynecol J. 2011;22(2):137–43.CrossRefGoogle Scholar
  24. 24.
    Gregory WT, Otto LN, Gergstrom JO, Clark AL. Surgical outcome of abdominal sacrocolpopexy with synthetic mesh versus abdominal sacrocolpopexy with cadaveric fascia lata. Int Urogynecol J. 2005;16(5):369–74.CrossRefGoogle Scholar
  25. 25.
    Quiroz LH, Gutman RE, Shippey S, Cundiff GW, Sanses T, Blomquist JL, et al. Abdominal sacrocolpopexy: anatomic outcomes and complications with Pelvicol, autologous and synthetic graft materials. Am J Obstet Gynecol. 2008;198(5):557.e1–5.CrossRefGoogle Scholar
  26. 26.
    Marcus-Braun N, von Theobald P. Mesh removal following transvaginal mesh placement: a case series of 104 operations. Int Urogynecol J. 2010;21(4):423–30.CrossRefGoogle Scholar
  27. 27.
    Tijdink MM, Vierhout ME, Heesakkers, Withagen MIJ. Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh. Int Urogynecol J. 2011;22(11):1395.CrossRefGoogle Scholar
  28. 28.
    Summers A, Winkel LA, Hussain HK, DeLancey JOL. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43.CrossRefGoogle Scholar
  29. 29.
    Chen L, Ashton-Miller JA, Hsu Y, DeLancey JOL. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006;108(2):324–32.CrossRefGoogle Scholar
  30. 30.
    Guiahi M. KentonK, Brubaker L. Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects. Int Urogynecol J. 2008;19(9):1267–70.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Division of UrologyUniversity of Colorado School of MedicineAuroraUSA

Personalised recommendations