Advertisement

Journal of Robotic Surgery

, Volume 11, Issue 2, pp 171–177 | Cite as

Robotic and laparoendoscopic single-site utero-sacral ligament suspension for apical vaginal prolapse: evaluation of our technique and perioperative outcomes

  • Hugo H DavilaEmail author
  • Taryn Gallo
  • Lindsey Bruce
  • Christopher Landrey
Original Article

Abstract

The objective of this study was to evaluate our technique and steps of robotic and laparoendoscopic single-site utero-sacral ligament suspension in the treatment of patients with symptomatic apical vaginal prolapse. A retrospective analysis was done using the data in 2 community hospital. Eighteen women presented with vaginal apex prolapse and desired minimally invasive surgery (video): (a) Laparoendoscopic single-site utero-sacral ligament suspension (LESS-UTSLS) (n = 13) or (b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) (n = 5) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative stage. Participants also completed validated questionnaire about pain scale. Multiples perioperative values were obtained to evaluate our minimally invasive approach. There were no differences in demographic, pre-operative anatomic, and functional data between groups. Concomitant anti-incontinence surgery with trans-obturator tape among the LESS-UTSLS vs RASS-UTSLS groups was performed in 2 (15 %) compared with 0 (0 %) and vaginal hysterectomy 2 (15 %) compared with supracervical hysterectomy 2 (40 %), respectively. The UTSLS operating time was similar in the RASS group compared with the LESS group (difference 9 min. There were only one POP (8 %) recurrence (stage 3) and one umbilical hernia (8 %) in the LESS-UTSLS group after 12 months of surgery. Two patients (15 %) developed stress urinary incontinence after LESS-UTSLS. We presented our technique and perioperative outcomes. RASS-UTSLS was similar operative times to LESS UTSL (+9 min), no differences in post-operative pain, anatomic support, or complications 6 months. We found that robotic surgical systems may accelerate the learning curve in the single-site surgery. Future investigations are warranted to discern the best applications for robotic single site technology in benign gynecologic surgery.

Keywords

Apical prolapsed Vaginal prolapsed Single-site surgery Robotic surgery Pelvic floor 

Notes

Compliance with ethical standards

Funding

None.

Conflict of interest

Hugo H. Davila, Taryn Gallo, Lindsey Bruce, and Christopher Landrey declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (MP4 343893 kb)

References

  1. 1.
    Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the women’s health initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166CrossRefPubMedGoogle Scholar
  2. 2.
    Webb MJ, Aronson MP, Ferguson LK, Lee RA (1998) Posthysterectomy vaginal vault prolapse: primary repair in 693 patients. Obstet Gynecol 92:281–285PubMedGoogle Scholar
  3. 3.
    Sze EH, Karram MM (1997) Transvaginal repair of vault prolapse: a review. Obstet Gynecol 89:466–475CrossRefPubMedGoogle Scholar
  4. 4.
    Silva WA, Pauls RN, Segal JL, Rooney CM, Kleeman SD, Karram MM (2006) Uterosacral ligament vault suspension five-year outcomes. Obstet Gynecol 108(2):255–263CrossRefPubMedGoogle Scholar
  5. 5.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506CrossRefPubMedGoogle Scholar
  6. 6.
    Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646–651PubMedGoogle Scholar
  7. 7.
    Nygaard IE, McCreery R, Brubaker L, Connolly AM, Cundiff G, Weber AM et al (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–823CrossRefPubMedGoogle Scholar
  8. 8.
    Cosson M, Rajabally R, Bogaert E, Querleu D, Crepin G (2002) Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures. JSLS 6:115–119PubMedPubMedCentralGoogle Scholar
  9. 9.
    Nezhat CH, Nezhat F, Nezhat C (1994) Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gynecol 84:885–888PubMedGoogle Scholar
  10. 10.
    Ostrzenski A (1996) Laparoscopic colposuspension for total vaginal prolapse. Int J Gynaecol Obstet 55:147–152CrossRefPubMedGoogle Scholar
  11. 11.
    Paraiso MFR, Jelovsek JE, Frick A, Chen CCG, Barber MD (2011) Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse. A randomized controlled trial. Obstet Gynecol 118:1005–1013CrossRefPubMedGoogle Scholar
  12. 12.
    Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C (2005) Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol 192:1752–1758CrossRefPubMedGoogle Scholar
  13. 13.
    Klauschie JL, Suozzi BA, O’Brien MM, McBride AW (2009) A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences. Int Urogynecol J Pelvic Floor Dysfunct 20:273–279CrossRefPubMedGoogle Scholar
  14. 14.
    Hsiao KC, Latchamsetty K, Govier FE, Kozlowski P, Kobashi KC (2007) Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse. J Endourol 21:926–930CrossRefPubMedGoogle Scholar
  15. 15.
    Geller EJ, Siddiqui NY, Wu JM, Visco AG (2008) Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol 112:1201–1206CrossRefPubMedGoogle Scholar
  16. 16.
    McCarthy M Jr, Jonasson O, Chang CH, Pickard AS, Giobbie-Hurder A, Gibbs J et al (2005) Assessment of patient functional status after surgery. J Am Coll Surg 201:171–178CrossRefPubMedGoogle Scholar
  17. 17.
    Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 60:39–45 (discussion 45) CrossRefPubMedGoogle Scholar
  18. 18.
    Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T et al (2010) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839CrossRefPubMedGoogle Scholar
  19. 19.
    Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5(10):561–568CrossRefPubMedGoogle Scholar
  20. 20.
    Lopez S, Mulla ZD, Hernandez L, Garza DM, Payne TN, Farnam RW (2016) A comparison of outcomes between robotic-assisted, single-site laparoscopy versus laparoendoscopic single site for benign hysterectomy. J Minim Invasive Gynecol 23(1):84–88CrossRefPubMedGoogle Scholar
  21. 21.
    Lopez S, Mulla ZD, Hernandez L, Garza DM, Payne TN, Farnam RW (2016) Robotic single-site hysterectomy: feasibility, learning curve and surgical outcome. Surg Endosc 27(7):2638–2643Google Scholar
  22. 22.
    Brandao LF, Laydner H, Zargar H, Torricelli F, Andreoni C, Kaouk J, Autorino R (2015) Laparoendoscopic single site surgery versus conventional laparoscopy for transperitoneal pyeloplasty: a systematic review and meta-analysis. Urol Ann 7(3):289–296PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Hugo H Davila
    • 1
    • 2
    • 3
    • 4
    Email author
  • Taryn Gallo
    • 3
  • Lindsey Bruce
    • 3
  • Christopher Landrey
    • 5
  1. 1.Florida Healthcare Specialist, Urology and Minimally Invasive SurgeryFlorida Cancer Specialist & Research InstituteVero BeachUSA
  2. 2.Florida Cancer Specialist & Research InstituteSebastianUSA
  3. 3.Department of Surgery, Division of Urology and GynecologySebastian River Medical CenterSebastianUSA
  4. 4.Florida State University College of MedicineTallahasseeUSA
  5. 5.Department of Surgery, Division of Gynecology and ObstetricsSt. Joseph Health SystemMichiganUSA

Personalised recommendations