Robotic-Assisted Laparoscopic Sacrocolpopexy in the Extreme Elderly: Safety and Feasibility

Abstract

<h3>Study Objective</h3> Robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) has evolved to be the standard of care for advanced stage pelvic organ prolapse (POP) repair in many women. Due to the variety of patients that undergo pelvic reconstructive surgery (PRS), it is important to identify risk stratification tools in the aging population in order to ensure positive outcomes in those undergoing RA-SCP for POP repair based on demographic risk factors. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> University-affiliated community hospital. <h3>Patients or Participants</h3> All women undergoing a RA-SCP by one surgeon (n=1078) between March 2017 and March 2020 were included. <h3>Interventions</h3> Four groups were compared based on age: <40 years of age (n=23), ≥40 but <60 (n=304), ≥60 but <80 (n=723), and ≥80 years of age (n=28). <h3>Measurements and Main Results</h3> Intraoperative complications including bladder, ureteral, or bowel injury, and blood transfusions were not statistically different between groups, as were rates of presentation within 90 days to the emergency department or for readmission to the hospital. Postoperatively, greater age groups presented with greater incidence of incontinence (0%, 5.3%, 9.1%, 14.3%, p<0.05). There were no statistically significant differences in acute urinary retention (p=0.90) or need for home catheterization (p=0.80) between groups. Greater age groups underwent less operative time (231, 229, 221, and 204 mins respectively, p<0.05), and required less morphine milligram equivalents (MME) during their hospital stay (30.3, 25.6, 18.1, and 15.6 MME respectively, p<0.05). <h3>Conclusion</h3> RA-SCP is a highly tolerable procedure. Surgeons should counsel patients that advancing age does not appear to increase the rate of complications or readmissions both during and after surgery. Decreased operative time for advancing age groups due to concern for anesthesia, prolonged Trendelenburg positioning, and patient frailty may help to decrease pain medication needs postoperatively.