PD21-06 PERIOPERATIVE OUTCOMES, COMPLICATIONS, AND EFFICACY OF ROBOTIC ASSISTED PROLAPSE REPAIR

Abstract

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Benign Disease1 Apr 2015PD21-06 PERIOPERATIVE OUTCOMES, COMPLICATIONS, AND EFFICACY OF ROBOTIC ASSISTED PROLAPSE REPAIR Michael Ehlert, Priyanka Gupta, Jamie Bartley, Kim A. Killinger, Jason Gilleran, and Melissa Fischer Michael EhlertMichael Ehlert More articles by this author , Priyanka GuptaPriyanka Gupta More articles by this author , Jamie BartleyJamie Bartley More articles by this author , Kim A. KillingerKim A. Killinger More articles by this author , Jason GilleranJason Gilleran More articles by this author , and Melissa FischerMelissa Fischer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Abdominal pelvic organ prolapse (POP) repair is efficacious and durable for uterovaginal and apical prolapse. Robotic technology has improved many aspects of open abdominal surgery, including blood loss and patient convalescence. We describe the safety and efficacy of robotic prolapse repair in a large teaching institution. METHODS Consecutive robotic assisted prolapse repairs by 4 surgeons at a single institution between 2006-2013. Charts were abstracted for patient characteristics, operative information, complications, prolapse outcomes and reoperations. Descriptive statistics were performed, and possible predictors for complication or prolapse recurrence explored. RESULTS 197 women underwent robotic prolapse repair (190 sacrocolpopexy, 6 sacrohysteropexy, 1 enterocele repair). Mean age at surgery was 61 ± 9 years with a mean follow-up of 13.6 ± 15 mo (range 0-85 mo). 40/197 (20%) had prior prolapse surgery, 102/197 (52%) prior hysterectomy, and 39/197 (20%) prior stress incontinence (SUI) procedure. At prolapse repair, concomitant procedures included hysterectomy (89), mid-urethral sling (85), posterior repair (10), Burch colposuspension (7). Mean OR time without hysterectomy was 205 ± 55 min and mean length of stay 1.42 days. Intraoperative complications were encountered in 13 women: cystotomy (4), vaginotomy (4), conversion to open (2), bowel injury/aborted (1), adhesions/aborted (1), ureteral injury (1). Women with complications had greater blood loss (p<0.001) than those without. Immediate (<30 d) post-op complications were rare: port-hernia (2), DVT (1), discitis (1), pelvic abscess (1), Ileus (1), ulnar neuropraxia (3), UTI (7). On follow-up 14 women had grade 3 POP (7 anterior, 7 posterior) and 5 had grade 2 apical prolapse. Of these, 9 (4.6%) women had additional prolapse repair at a mean of 9.5 ± 6.3 mo, (4 anterior, 5 posterior). There were no clinical or operative predictors of recurrent prolapse. In women with follow-up exams, vaginal mesh exposure was detected in 12/192 (6.3%). There were 6 procedures for mesh exposure (1 office, 5 OR) and 2 procedures for exposed sutures (1 office, 1 OR). There was one mesh erosion into the bladder requiring open excision. CONCLUSIONS In this largest reported series of robotic prolapse repair, complications are infrequent. Prolapse outcomes are durable with no grade 3 apical failures. Few women require additional compartment repairs within 1 year with low rates of mesh exposure. We identified no predictors for complications or recurrent prolapse. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e473 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Ehlert More articles by this author Priyanka Gupta More articles by this author Jamie Bartley More articles by this author Kim A. Killinger More articles by this author Jason Gilleran More articles by this author Melissa Fischer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...