Abstract
The aim of the study was to evaluate the short-term success of robotic sacrocolpopexy using the Quill bi-directional polydioxanone (PDO) suture. This was a retrospective observation study of women undergoing robotic sacrocolpopexy performed by a single surgeon between May 2008 and August 2010. Pelvic organ prolapse was determined using the pelvic organ prolapse quantification scale (POP-Q). Baseline exam were performed preoperatively and scheduled at 6 weeks, 3 months, and yearly thereafter. Treatment success defined as a POP-Q measurement of point C that did not descend for more than one-half the total vaginal length and a measurement for point Ba that was less than −1. A total of 36 patients were eligible for enrolment in the study. The mean age was 70 years (range 49–86 years), and mean body mass index was 27 kg/m2 (range 19–41 kg/m2). The mean interval follow-up was 166 days (median 116; range 34–772 days). Anatomic success was 92% (33/36). In the short term, the Quill SRS PDO suture provided sufficient fixation of an Amid type I polypropylene mesh to the vagina to result in excellent anatomic success with only rare complications.
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Acknowledgments
The author wishes to thank Drs. Lennox Hoyte and Tom Julian for their encouragement and editorial insight. Statistical analysis was performed by Ron Fisher, PhD, at Fisher Statistics.
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Appendix
Appendix
Introduced in 1996, the Pelvic Organ Prolapse Quantification (POP-Q) system is an objective, site-specific system used for describing and staging pelvic support in women. There are nine points of measure, with six of these points being measured relative to the hymen. Points above the hymen are negative, points below the hymen are positive, and points at the hymen are zero. All measurements are recorded in centimeters. Patients are examined in the supine position with an empty bladder, and except for TVL (total vaginal length), all measurements are taken with the patient performing maximum Valsalva effort.
Point | Description | Range |
|---|---|---|
Aa | Midline anterior vagina 3 cm proximal to the hymen | −3 to +3 cm |
Ba | Most dependent part anterior vagina | −3 cm to + TVL |
C | Cervix or vaginal cuff | + or −TVL |
D | Posterior fornix (N/A if post-hysterectomy) | + or −TVL |
Ap | Midline posterior vagina 3 cm proximal to the hymen | −3 to +3 cm |
Bp | Most dependent part of posterior vagina | −3 cm to +TVL |
GH (genital hiatus) | Distance from middle external urethral meatus to posterior midline hymen | >0 |
PB (perineal body) | Distance from posterior midline hymen to middle of anal opening | >0 |
TVL (total vaginal length) | Greatest depth of vagina when point C or D is reduced to normal position | −3 cm to +TVL |
Stage 0 (no prolapse) | Points Aa, Ap, Ba, Bp all = −3 cm and either point C or D ≤ (TVL −2) cm |
Stage I | Criteria for stage 0 are not met and leading edge of prolapse < −1 cm |
Stage II | Leading edge of prolapse ≥ −1 cm, but ≤ +1 cm |
Stage III | Leading edge of prolapse > +1 cm, but < +(TVL − 2) cm |
Stage IV | Leading edge of prolapse ≥ +(TVL − 2) cm |
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Stubbs, J.T. Short-term results of robotic sacrocolpopexy using the Quill SRS bi-directional polydioxanone (PDO) suture. J Robotic Surg 5, 259–265 (2011). https://doi.org/10.1007/s11701-011-0267-6
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DOI: https://doi.org/10.1007/s11701-011-0267-6