Current Obstetrics and Gynecology Reports

, Volume 6, Issue 3, pp 243–248 | Cite as

Conventional Laparoscopy vs. Robotic-Assisted Laparoscopy for Sacrocolpopexy and Sacrocervicopexy: a Review

Urogynecology (S Pulliam and N Kohli, Section Editors)
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Part of the following topical collections:
  1. Topical Collection on Urogynecology

Abstract

Purpose of Review

An abdominal approach to apical pelvic organ prolapse surgery yields superior outcomes in terms of decreased recurrence rates. Furthermore, there is evidence to support that a minimally invasive approach yields better patient outcomes over an abdominal approach. However, there remains debate in the field over which minimally invasive approach is better. In this review, we compare conventional straight stick laparoscopy and robotic-assisted laparoscopy techniques for sacrocolpopexy and sacrocervicopexy (LSC and RASC).

Recent Findings

We reviewed data from recent retrospective and prospective studies that directly compare LSC and RASC. In particular, we considered complications, operative time, patient outcomes, and cost.

Summary

Both LSC and RASC have benefits over the traditional open abdominal approach. Complication rates are low and resolution of prolapse is high in both LSC and RASC. Operative time and costs are generally higher in RASC. The existing studies comparing LSC and RASC have relatively small sample sizes. It will be important for further robust prospective studies to directly compare these two common minimally invasive approaches to pelvic organ prolapse.

Keywords

Minimally invasive surgery Sacrocolpopexy Urogynecology Robotic surgery Laparoscopic surgery Pelvic organ prolapse 
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Notes

Compliance with Ethical Standards

Conflict of Interest

Marron Wong and Stephanie Morris declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Swift SE. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277–85.CrossRefPubMedGoogle Scholar
  2. 2.
    • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Libr. 2016; This Cochrane review found that compared to vaginal sacrospinous colpopexy, abdominal sacrocolpopexies were associated with less recurrent prolapse and postoperative dyspareunia. Google Scholar
  3. 3.
    Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Pelvic Floor Disorders Network. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Nezhat CH, Nezhat F, Nezhat C. Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gynecol. 1994;84(5):885–8.PubMedGoogle Scholar
  5. 5.
    Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55(5):1089–105.CrossRefPubMedGoogle Scholar
  6. 6.
    Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C. Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol. 2005;192(5):1752–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC. Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol. 2007;21(8):926–30.CrossRefPubMedGoogle Scholar
  8. 8.
    Klauschie JL, Suozzi BA, O’Brien MM, McBride AW. A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences. Int Urogynecol J. 2009;20(3):273–9.CrossRefGoogle Scholar
  9. 9.
    Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24(3):377–84.CrossRefPubMedGoogle Scholar
  10. 10.
    Miklos JR, Moore RD. The 26-Minute Laparoscopic Sacral Colpopexy: Do we really need robotic technology? J Minim Invasive Gynecol. 2015;22(5):712.CrossRefPubMedGoogle Scholar
  11. 11.
    Di Marco DS, Chow GK, Gettman MT, Elliott DS. Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse. Urology. 2004;63(2):373–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Geller EJ, Parnell BA, Dunivan GC. Robotic vs abdominal sacrocolpopexy: 44-month pelvic floor outcomes. Urology. 2012;79(3):532–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Elliott CS, Hsieh MH, Sokol ER, Comiter CV, Payne CK, Chen B. Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis. J Urol. 2012;187(2):638–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Siddiqui NY, Geller EJ, Visco AG. Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy. Am J Obstet Gynecol. 2012;206(5):435–e1.CrossRefPubMedGoogle Scholar
  15. 15.
    Hoyte L, Rabbanifard R, Mezzich J, Bassaly R, Downes K. Cost analysis of open versus robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012;18(6):335–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Pollard ME, Eilber KS, Anger JT. Abdominal approaches to pelvic prolapse repairs. Curr Opin Urol. 2013;23(4):306–11.CrossRefPubMedGoogle Scholar
  17. 17.
    American College of Obstetricians and Gynecologists. Robotic surgery in gynecology. Committee Opinion No. 628. Obstet Gynecol. 2015;125:760–7.CrossRefGoogle Scholar
  18. 18.
    Mustafa S, Amit A, Filmar S, Deutsch M, Netzer I, Itskovitz-Eldor J, et al. Implementation of laparoscopic sacrocolpopexy: establishment of a learning curve and short-term outcomes. Arch Gynecol Obstet. 2012;286(4):983–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55(6):1459–68.CrossRefPubMedGoogle Scholar
  20. 20.
    Germain A, Thibault F, Galifet M, Scherrer ML, Ayav A, Hubert J, et al. Long-term outcomes after totally robotic sacrocolpopexy for treatment of pelvic organ prolapse. Surg Endosc. 2013;27(2):525–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Lenihan JP, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol. 2008;15(5):589–94.CrossRefPubMedGoogle Scholar
  22. 22.
    • Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13. This RCT of 78 patients found that after LSC and RASC, patients had the same support and functional outcomes at one year of follow up. The RASC group had longer operating times, increased costs, and higher postoperative pain scores. CrossRefPubMedGoogle Scholar
  23. 23.
    • Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Robotic-assisted and laparoscopic sacrocolpopexy: comparing operative times, costs and outcomes. Female Pelvic Med Reconstr Surg. 2011;17(1):44–9. This retrospective cohort study of 104 patients compared LSC and RASC and found no difference in complication rates, blood loss, or objective cure rates. RASC required longer operative times and higher cost. CrossRefPubMedGoogle Scholar
  24. 24.
    Awad N, Mustafa S, Amit A, Deutsch M, Eldor-Itskovitz J, Lowenstein L. Implementation of a new procedure: laparoscopic versus robotic sacrocolpopexy. Arch Gynecol Obstet. 2013;287(6):1181–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Pulliam SJ, Weinstein MM, Wakamatsu MM. Minimally invasive apical sacropexy: a retrospective review of laparoscopic and robotic operating room experiences. Female Pelvic Med Reconstr Surg. 2012;18(2):122–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Antosh DD, Grotzke SA, McDonald MA, Shveiky D, Park AJ, Gutman RE, et al. Short-term outcomes of robotic versus conventional laparoscopic sacral colpopexy. Female Pelvic Med Reconstr Surg. 2012;18(3).Google Scholar
  27. 27.
    • Seror J, Yates DR, Seringe E, Vaessen C, Bitker MO, Chartier-Kastler E, et al. Prospective comparison of short-term functional outcomes obtained after pure laparoscopic and robot-assisted laparoscopic sacrocolpopexy. World J Urol. 2012;30(3):393–8. This two year, prospective, non-randomized study of 67 patients showed no difference in anatomic repair rates, PFDI-20 scores, or total operative time between LSC and RASC. The RASC group had significantly less blood loss. CrossRefPubMedGoogle Scholar
  28. 28.
    • Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014;123(1):5. This RCT of 78 women randomized to LSC or RASC showed no difference in short term complications or short term outcomes, but RASC costs were significantly higher. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    • Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynecol Obstet. 2016;132(3):284–91. A thorough systematic review looking at data from seven studies comparing LSC and RASC, finding RASC to be associated with higher cost and longer operating times. CrossRefGoogle Scholar
  30. 30.
    White WM, Goel RK, Swartz MA, Moore C, Rackley RR, Kaouk JH. Single-port laparoscopic abdominal sacral colpopexy: initial experience and comparative outcomes. Urology. 2009;74(5):1008–12.CrossRefPubMedGoogle Scholar
  31. 31.
    • Lee RK, Mottrie A, Payne CK, Waltregny D. A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol. 2014;65(6):1128–37. A review of the literature through 2013 comparing LSC and RASC, including 1584 total patients. Objective cure rates were >90% in both LSC and RASC, and RASC had longer operative times. CrossRefPubMedGoogle Scholar
  32. 32.
    Marshall DD, George SA, McDonald MA, Shveiky D, Park AJ, Gutman RG, et al. Short-term outcomes of robotic vs. conventional laparoscopic sacrocolpopexy. J Minim Invasive Gynecol. 2010;17(6):S89.CrossRefGoogle Scholar
  33. 33.
    Unger CA, Paraiso MF, Jelovsek JE, Barber MD, Ridgeway B. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547–e1.Google Scholar
  34. 34.
    Judd JP, Siddiqui NY, Barnett JC, Visco AG, Havrilesky LJ, Wu JM. Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol. 2010;17(4):493–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Nieboer TE, Aarts JW. Robotic Compared With Laparoscopic Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol. 2014;123(6):1357–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Linder BJ, Anand M, Weaver AL, Woelk JL, Klingele CJ, Trabuco EC, et al. Assessing the learning curve of robotic sacrocolpopexy. Int Urogynecol J. 2016;27(2):239–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Loring M, Kohli N, Morris SN. Same day discharge after laparoscopic sacrocervicopexy. Female Pelvic Med Reconstr Surg. 2015;21(5):S140.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Center for Minimally Invasive Gynecologic SurgeryNewton-Wellesley HospitalNewtonUSA

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