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Robotic or laparoscopic sacrohysteropexy versus open sacrohysteropexy for uterus preservation in pelvic organ prolapse

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Abstract

Introduction and hypothesis

The aim of this study was to compare robotic or laparoscopic sacrohysteropexy (RLSH) and open sacrohysteropexy (OSH) as a surgical treatment for pelvic organ prolapse (POP).

Methods

Among 111 consecutive patients who had undergone sacrohysteropexy for POP, surgical outcomes and postoperative symptoms were compared between the RLSH (n = 54; robotic 14 cases and laparoscopic 40 cases) and OSH (n = 57). groups The medical records of enrolled patients were reviewed retrospectively.

Results

Compared with the OSH group, the RLSH group had shorter operating time (120.2 vs 187.5 min, p < 0.0001), less operative bleeding (median estimated blood loss 50 vs 150 ml; p < 0.0001; mean hemoglobin drop 1.4 vs 2.0 g/dl; p < 0.0001), and fewer postoperative symptoms (13 vs 45.6 %; p < 0.0001). Patients’ overall satisfaction (94.4 vs 91.2 %; p = 0.717) and required reoperation due to postoperative complications (3.7 vs 1.8 %; p = 0.611) did not differ between groups.

Conclusions

RLSH could be a feasible and safe procedure in patients with POP and should be considered as a surgical option that allows preservation of the uterus. Prospective randomized trials will permit the evaluation of potential benefits of RLSH as a minimally invasive surgical approach.

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References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506. doi:10.1016/s0029-7844(97)00058-6

    Article  CAS  PubMed  Google Scholar 

  2. Jelovsek JE, Maher C, Barber MD (2007) Pelvic organ prolapse. Lancet 369:1027–1038. doi:10.1016/s0140-6736(07)60462-0

    Article  PubMed  Google Scholar 

  3. Dietz HP (2008) The aetiology of prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19:1323–1329. doi:10.1007/s00192-008-0695-7

    Article  CAS  PubMed  Google Scholar 

  4. Mothes AR, Radosa MP, Altendorf-Hofmann A, Runnebaum IB (2015) Risk index for pelvic organ prolapse based on established individual risk factors. Arch Gynecol Obstet. doi:10.1007/s00404-015-3863-2

    Google Scholar 

  5. Thys SD, Roovers JP, Geomini PM, Bongers MY (2012) Do patients prefer a pessary or surgery as primary treatment for pelvic organ prolapse. Gynecol Obstet Investig 74:6–12. doi:10.1159/000336634

    Article  CAS  Google Scholar 

  6. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, Zyczynski H, Network PFD (2004) Abdominal sacral colpopexy: a comprehensive review. Obstet Gynecol 104:805–823

    Article  PubMed  Google Scholar 

  7. Ridgeway BM (2015) Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse. Am J Obstet Gynecol. doi:10.1016/j.ajog.2015.07.035

    Google Scholar 

  8. Korbly NB, Kassis NC, Good MM, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Lopes VV, Harvie HS, Sung VW (2013) Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol 209:470–e1-6. doi:10.1016/j.ajog.2013.08.003

    PubMed  Google Scholar 

  9. Frick AC, Barber MD, Paraiso MF, Ridgeway B, Jelovsek JE, Walters MD (2013) Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse. Female Pelvic Med Reconstr Surg 19:103–109. doi:10.1097/SPV.0b013e31827d8667

    Article  PubMed  Google Scholar 

  10. Barranger E, Fritel X, Pigne A (2003) Abdominal sacrohysteropexy in young women with uterovaginal prolapse: long-term follow-up. Am J Obstet Gynecol 189:1245–1250. doi:10.1067/S0002-9378(03)00665-3

    Article  PubMed  Google Scholar 

  11. Leron E, Stanton SL (2001) Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse. BJOG 108:629–633. doi:10.1111/j.1471-0528.2001.00138.x

    CAS  PubMed  Google Scholar 

  12. Moiety FM, Hegab HM, Ghanem IA, Zedan WM, Salem HA (2010) Abdominal sacrohysteropexy for uterovaginal prolapse: a prospective study on 33 cases. Arch Gynecol Obstet 281:631–636. doi:10.1007/s00404-009-1146-5

    Article  PubMed  Google Scholar 

  13. Jeon MJ, Jung HJ, Choi HJ, Kim SK, Bai SW (2008) Is hysterectomy or the use of graft necessary for the reconstructive surgery for uterine prolapse? Int Urogynecol J Pelvic Floor Dysfunct 19(3):351–355

    Article  PubMed  Google Scholar 

  14. Costantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A (2013) Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy. Int Urogynecol J 24:1481–1487. doi:10.1007/s00192-012-2041-3

    Article  PubMed  Google Scholar 

  15. Gutman R, Maher C (2013) Uterine-preserving POP surgery. Int Urogynecol J 24:1803–1813. doi:10.1007/s00192-013-2171-2

    Article  PubMed  Google Scholar 

  16. Rosati M, Bramante S, Bracale U, Pignata G, Azioni G (2013) Efficacy of laparoscopic sacrocervicopexy for apical support of pelvic organ prolapse. JSLS 17:235–244. doi:10.4293/108680813X13654754535115

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rosati M, Bramante S, Conti F (2014) A review on the role of laparoscopic sacrocervicopexy. Curr Opin Obstet Gynecol 26:281–289. doi:10.1097/GCO.0000000000000079

    Article  PubMed  Google Scholar 

  18. Li S, Ji M, Zhao Z (2015) The effectiveness of two different laparoscopic surgeries for apical support of pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 188:74–78. doi:10.1016/j.ejogrb.2015.03.007

    Article  PubMed  Google Scholar 

  19. Demirci F, Ozdemir I, Somunkiran A, Topuz S, Iyibozkurt C, Duras Doyran G, Kemik Gul O, Gul B (2007) Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures. Int Urogynecol J Pelvic Floor Dysfunct 18:257–261. doi:10.1007/s00192-006-0134-6

    Article  PubMed  Google Scholar 

  20. Richter HE, Goode PS, Kenton K, Brown MB, Burgio KL, Kreder K, Moalli P, Wright EJ, Weber AM (2007) The effect of age on short-term outcomes after abdominal surgery for pelvic organ prolapse. J Am Geriatr Soc 55:857–863. doi:10.1111/j.1532-5415.2007.01178.x

    Article  PubMed  Google Scholar 

  21. Germain A, Thibault F, Galifet M, Scherrer ML, Ayav A, Hubert J, Brunaud L, Bresler L (2013) Long-term outcomes after totally robotic sacrocolpopexy for treatment of pelvic organ prolapse. Surg Endosc 27:525–529. doi:10.1007/s00464-012-2472-4

    Article  CAS  PubMed  Google Scholar 

  22. Yoo HN, Kim TJ, Lee YY, Choi CH, Lee JW, Bae DS, Kim BG (2015) Single-site robotic surgery in gynecologic cancer: a pilot study. J Gynecol Oncol 26:62–67. doi:10.3802/jgo.2015.26.1.62

    Article  PubMed  PubMed Central  Google Scholar 

  23. Buchs NC, Pugin F, Ris F, Volonte F, Morel P, Roche B (2013) Early experience with robotic rectopexy. Int J Med Robot 9:e61–e65. doi:10.1002/rcs.1498

    Article  PubMed  Google Scholar 

  24. Barbash GI, Glied SA (2010) New technology and health care costs--the case of robot-assisted surgery. N Engl J Med 363:701–704. doi:10.1056/NEJMp1006602

    Article  CAS  PubMed  Google Scholar 

  25. Zucchi A, Lazzeri M, Porena M, Mearini L, Costantini E (2010) Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 7:626–633. doi:10.1038/nrurol.2010.164

    Article  PubMed  Google Scholar 

  26. Price N, Slack A, Jackson SR (2010) Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 117:62–68. doi:10.1111/j.1471-0528.2009.02396.x

    Article  PubMed  Google Scholar 

  27. van IJsselmuiden MN, Coolen AL, Detollenaere RJ, den Boon J, Bongers M, van de Pol G, Vollebregt A, Radder CM, Deprest J, van Eijndhoven HW (2014) Hysteropexy in the treatment of uterine prolapse stage 2 or higher: a multicenter randomized controlled non-inferiority trial comparing laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy (LAVA-trial, study protocol). BMC Womens Health 14:112. doi:10.1186/1472-6874-14-112

    Article  PubMed  PubMed Central  Google Scholar 

  28. Detollenaere RJ, den Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, van Eijndhoven HW (2015) Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ 351:h3717. doi:10.1136/bmj.h3717

    Article  PubMed  PubMed Central  Google Scholar 

  29. Seror J, Yates DR, Seringe E, Vaessen C, Bitker MO, Chartier-Kastler E, Roupret M (2012) Prospective comparison of short-term functional outcomes obtained after pure laparoscopic and robot-assisted laparoscopic sacrocolpopexy. World J Urol 30:393–398. doi:10.1007/s00345-011-0748-2

    Article  PubMed  Google Scholar 

  30. Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112:1201–1206. doi:10.1097/AOG.0b013e31818ce394

    Article  PubMed  Google Scholar 

  31. Vitobello D, Siesto G, Bulletti C (2012) Robotic sacral hysteropexy for pelvic organ prolapse. Int J Med Robot 8:114–117. doi:10.1002/rcs.447

    Article  PubMed  Google Scholar 

  32. Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309:689–698. doi:10.1001/jama.2013.186

    Article  CAS  PubMed  Google Scholar 

  33. Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S, Uccella S, Cromi A, Ghezzi F (2014) Robot-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review and meta-analysis of comparative studies. Eur Urol 66:303–318. doi:10.1016/j.eururo.2014.02.053

    Article  PubMed  Google Scholar 

  34. Pan K, Cao L, Ryan NA, Wang Y, Xu H (2015) Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J. doi:10.1007/s00192-015-2775-9

    Google Scholar 

  35. Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, Sanses TV, Steinberg AC, South MM, Balk EM, Sung VW, Society of Gynecologic Surgeons Systematic Review Group (2015) Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol 125:44–55. doi:10.1097/AOG.0000000000000570

    Article  PubMed  PubMed Central  Google Scholar 

  36. Desille-Gbaguidi H, Hebert T, Paternotte-Villemagne J, Gaborit C, Rush E, Body G (2013) Overall care cost comparison between robotic and laparoscopic surgery for endometrial and cervical cancer. Eur J Obstet Gynecol Reprod Biol 171:348–352. doi:10.1016/j.ejogrb.2013.09.025

    Article  CAS  PubMed  Google Scholar 

  37. Fader AN, Seamon LG, Escobar PF, Frasure HE, Havrilesky LA, Zanotti KM, Secord AA, Boggess JF, Cohn DE, Fowler JM, Skafianos G, Rossi E, Gehrig PA (2012) Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers. Gynecol Oncol 126:180–185. doi:10.1016/j.ygyno.2012.04.028

    Article  PubMed  Google Scholar 

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    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea

      Jiheum Paek

    2. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

      Maria Lee

    3. Department of Obstetrics and Gynecology, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, 150 Sung-an ro, Kangdong-gu, Seoul, 134-701, Korea

      Bo Wook Kim & Yongil Kwon

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    1. Jiheum Paek
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    2. Maria Lee
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    Correspondence to Yongil Kwon.

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    Jiheum Paek and Maria Lee contributed equally to this work.

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    Paek, J., Lee, M., Kim, B.W. et al. Robotic or laparoscopic sacrohysteropexy versus open sacrohysteropexy for uterus preservation in pelvic organ prolapse. Int Urogynecol J 27, 593–599 (2016). https://doi.org/10.1007/s00192-015-2869-4

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