Robotic-assisted Sacrocolpopexy Research Articles

Cost comparison of laparoscopic and robotic assisted sacrocolpopexy

Cost comparison of laparoscopic and robotic assisted sacrocolpopexy

Evaluation of robotic-assisted sacrocolpopexy videos on YouTube.

To evaluate the quality and reliability of videos on YouTube about robotic-assisted sacrocolpopexy. YouTube's search function was used to find videos associated with robotic-assisted sacrocolpopexy. On June 1, 2022, systematic research was performed using the term "robotic-assisted sacrocolpopexy". The first 50 videos were included in the study. The quality of the videos was evaluated using the Global Quality Scale (GQS) [a 5-point scale: high quality (4 or 5), acceptable quality (3), low quality (1 or 2)]. The modified DISCERN scale was used to evaluate the reliability of the videos [a 5-point scale: high reliability (5), moderate reliability (3 and 4), low reliability (1 or 2)]. A total of 50 videos associated with robotic-assisted sacrocolpopexy were analyzed. The most frequently discussed topics in the videos were the duration of the surgery (72%), the anatomical success rates (70%), the advantages and disadvantages of the procedure compared to the classical methods (68%), and the postoperative complications (60%). The mean GQS of the videos was 3.04 ± 0.75. The mean DISCERN score of the videos was 2.21 ± 1. No appropriate references were cited in any of the videos. There was no video that received a full score (5 points) from DISCERN. Our study shows that the level of quality in YouTube videos associated with robotic-assisted sacrocolpopexy is at an acceptable and high level, but its reliability is low. Therefore, short and concise videos that contain accurate information and refer to scientific facts should be prepared by urogynecology associations.

Prevalence and risk factors of lower urinary tract symptoms after robotic sacrocolpopexy

Aims: To analyze the prevalence and risk factors for postoperative lower urinary tract symptoms (LUTS) in women submitted to robot-assisted sacrocolpopexy (RASC) for correction of pelvic organ prolapse (POP). Methods: A longitudinal prospective study was carried out on 51 consecutive women who underwent RASC to treat POP. We recorded preoperatively the presence of LUTS urgency, symptomatic stress urinary incontinence (SUI), and voiding difficulty. We also performed an urodynamic study prior to surgical intervention including an incontinence test for overt and occult stress urinary incontinence (with POP reduction). A transobturator suburethral sling (TOT) was implanted in patients with demonstrable urodynamic SUI (overt or occult). Patients' LUTS were reassessed at 6 months after the surgical intervention. McNemar test and the Fisher exact test were used to analyzing dependent variables and Student’s t - test for independent variables. Statistical significance was set at p ≤ 0.05. Results: Postoperative voiding difficulty and symptomatic SUI were significantly reduced. No significant differences were observed in the postoperative prevalence of urgency. The presence of preoperative urinary urgency was the only significant risk factor of postoperative urgency, whereas TOT placement was the only significative factor associated with postoperative symptomatic SUI. TOT placement in patients with occult SUI significantly reduced postoperative Symptomatic SUI. Conclusion: RASC reduces the prevalence of voiding difficulty but not urgency. Concomitant implantation of TOT in patients with preoperative urodynamic SUI (overt or occult) is useful to reduce symptomatic postoperative SUI.

Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms.

Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5±9.7, BMI 27.9±4.7, and parity 2.5±1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ=32.1 min, p=0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p>0.05). On univariable analysis, costs were similar (Senhance $5368.31±1486.89, DaVinci $5741.76±1197.20, p=0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p>0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p=0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.

Postoperative adverse events and re-treatment among patients who have undergone laparoscopic and robotic sacrocolpopexy for pelvic organ prolapse in Japan.

To describe and compare the postoperative adverse events and re-treatment for recurrence after laparoscopic and robotic-assisted sacrocolpopexy in Japanese patients with pelvic organ prolapse (POP). This was a retrospective cohort study using the DeSC database, which contains claims and medical check-up data provided by DeSC Healthcare Inc., Tokyo, Japan. We identified all patients who had undergone either laparoscopic or robotic-assisted sacrocolpopexy from April 2014 to May 2021. Patient backgrounds and postoperative outcomes were compared between the laparoscopic and robotic-assisted sacrocolpopexy groups. Moreover, the composite adverse event comprising vaginal erosion, postoperative urinary incontinence, postoperative dysuria, urinary tract injury, and abdominal incisional hernia was evaluated. Re-treatment for POP recurrence included pessary use and surgery for POP was also evaluated. Among 28 748 patients diagnosed with POP, 409 (1.4%) had undergone laparoscopic sacrocolpopexy and 52 (0.2%) had undergone robotic-assisted sacrocolpopexy. The prevalence of postoperative adverse events was 20.8% and 13.5% in the laparoscopic and robotic-assisted sacrocolpopexy groups, respectively (P= 0.270). One patient (1.9%) underwent surgery after robotic-assisted sacrocolpopexy, and none of the patients was administered pessaries postoperatively in both groups. In Japan, postoperative outcomes after laparoscopic and robotic-assisted sacrocolpopexy are similar and comparable to those reported in western countries.

De novo pain and relief of pain after abdominal synthetic mesh implants

Introduction:This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Methods:Prospective observational cohort study (NCT01598467, clinical trials.gov) performed in a tertiary referral center for patients with gynecological prolapse. Women undergoing robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy for the treatment of pelvic organ prolapse were​ included (2014–2018). Primary outcome was presence and degree of pre- and postoperative pain. Secondary outcomes were quality of life, dyspareunia and risk factors for postoperative pain. Pre- and postoperative interviews and validated questionnaires were used to assess pain severity and location. A Numeric rating scale (NRS; 0-10; 0 no pain and 10 highest pain score) was included in the questionnaire. ‘De novo pain’, ‘ongoing pain’ and ‘resolved pain’ were respectively described as: Pain solely present postoperatively, pain present both pre- and postoperatively and pain present preoperatively, but resolved postoperatively. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the quality of life Pelvic Floor Impact Questionnaire (PFIQ-7) were used. Results:115 subjects who underwent abdominal mesh implant surgery were included. Mean follow-up duration was 12.8 3.7 months. The preoperative prevalence of patient self-reported pain was 52%, postoperative self-reported pain was 24%. De novo pain was found in 4.3%. Self-reported ongoing pain was noted in 18%. In 29%of patients the pain had resolved after surgery. Preoperative pain and previous intra-abdominal surgery were identified risk factors for postoperative pain (intra-abdominal surgery OR 3.6, 95% CI 1.2-10.7; preoperative NRS pain score OR 1.4, 95% CI 1.1-1.7). Less women reported dyspareunia postoperatively (49% versus 36%). Total PFIQ-7 scores decreased significantly (Total PFIQ-7: -49) postoperatively, indicating improvement in quality of life. Conclusion:Pain is mostly reduced or resolved and less dyspareunia is reported after abdominal pelvic floor surgery with mesh implants for pelvic organ prolapse.

Single-center study for robotic-assisted laparoscopic sacropexies: a one-fits-all strategy for pelvic organ prolapse?

PurposeSarcopenia has been established as the “gold standard” for the treatment of pelvic organ prolapse (POP). Minimal invasive laparoscopy can help to reduce the risks of open access surgery. We compare the surgical results and outcomes of robotic-assisted sacropexies.MethodsIn this monocentric retrospective study we enrolled 49 patients operated on symptomatic POP. Patients were divided into two groups according to the type of robotic-assisted sacropexy: patients with a history of hysterectomy received robotic-assisted sacrocolpopexy (RSCP; n = 19), while patients with subtotal hysterectomy received robotic-assisted cervicosacropexy (RCSP; n = 30). Failure was defined as recurrence of the disease with a need for reoperation. Validated questionnaires (the Pelvic Floor Distress Inventory—20 (PFDI-20) and Pelvic Floor Impact Questionnaire—7 (PFIQ-7)), were used for evaluation of patients quality of life postoperatively.ResultsThe comparison between RCSP versus RSCP showed that the latter is related to slightly but not significantly increased recurrence rates and a higher impact of POP symptoms on quality of life in long-term follow-up (p = 0.04). Perioperative data showed similar complication rates in both RSP types but shorter postoperative time of bladder catheterization in the case of RCSP (p = 0.008).ConclusionsThe monocentric long-term data confirm that RSP is a safe and effective method of surgical POP treatment, regardless of the site of the anatomical compartment. In comparison to RSCP, RCSP is associated with a lower impact of POP symptoms on patients’ quality of life with a tendency to slightly lower rates of POP recurrence.

SHORT-TERM SURGICAL AND FUNCTIONAL OUTCOMES AFTER ROBOT-ASSISTED SACROCOLPOPEXY IN A SINGLE INSTITUTION

(Objectives) This study aimed to evaluate the surgical outcomes and functional parameters of lower urinary tract and bowel symptoms in patients who have undergone robot-assisted sacrocolpopexy (RASC) due to pelvic organ prolapse. (Patients and methods) This retrospective study included 110 consecutive RASC cases in the urology department of Ageo Central General Hospital, Japan, from November 2020 to October 2021. The medical records of these patients were retrieved. Data on uroflowmetry, post-void residual urine test, and self-administered questionnaires on urination and defecation were assessed. (Results) The mean operating time was 146 min, and the estimated blood loss was 14.8 ml. The intraoperative, postoperative, and severe complication rates of cases classified as Clavien-Dindo grade IIIa or higher were 0%, 9.1%, and 0%, respectively. The maximum flow rate and post-void residual volume of urine significantly improved after the operation. Similarly, the quality of life (QOL) scores and overactive bladder symptom score (OABSS), as well as the responses for the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Urinary Distress Inventory-6 (UDI-6), significantly improved one month after the operation and were sustained for six months. On the other hand, the total scores from the Constipation Scoring System (CSS) and the subscales of the Patient Assessment of Constipation (PAC) -QOL worsened. These scores, except for those of the PAC-QOL satisfaction subscale recovered to the preoperative levels; the PAC-QOL satisfaction subscale scores significantly improved six months postoperatively. The rates of de novo overactive bladder (OAB), stress urinary incontinence (SUI), and constipation one month postoperatively were 8%, 33%, and 10%, respectively. (Conclusions) RASC was performed safely in our institution with acceptable postoperative lower urinary tract and bowel outcomes.

Comparison of transvaginal mesh surgery and robot-assisted sacrocolpopexy for pelvic organ prolapse

BackgroundPelvic organ prolapse (POP) is greatly affecting the quality of life (QOL) of women. There are some surgical techniques for POP repair, for example, transvaginal mesh surgery (TVM), laparoscopic sacrocolpopexy (LSC), and robot-assisted sacrocolpopexy (RSC). In the United States and Europe, the number of TVM has rapidly decreased since 2011 due to complications and safety concerns and has shifted to LSC/RSC. In Japan, RSC has increased after the insurance coverage of RSC in 2020. Therefore, we compared the surgical outcomes of TVM and RSC in POP surgery.MethodsWe retrospectively collected POP surgery underwent TVM or RSC at our hospital and compared the operative time, blood loss, postoperative hospital stay, postoperative complications, and preoperative and postoperative stress urinary incontinence (SUI) of two groups. Preoperative and postoperative SUI were classified into 3 groups: “improved preoperative SUI”, “persistent preoperative SUI” and “de novo SUI”, which occurred for the first time in patients with no preoperative SUI, and compared incidence rate. The Mann–Whitney U test and Fisher’s exact test were used to compare the two groups, and P < 0.05 was considered statistically significant.ResultsFrom August 2011 to July 2021, 76 POP surgery was performed and they were classified into two groups: TVM group (n = 39) and RSC group (n = 37). There was no difference in patient age and BMI between the TVM and RSC groups. The median of operative time was 78.0 vs. 111.0 min (p = 0.06), blood loss was 20.0 ml vs. 5.0 ml (p < 0.05), and postoperative hospital stay was 4.0 days vs. 3.0 days (p < 0.05), with less blood loss and shorter postoperative hospital stay in the RSC group. There was no difference in postoperative complications between the TVM and RSC groups (17.9% vs. 16.2%, p = 1.00). De novo SUI was 25.6% vs. 5.4% (p < 0.05) in the TVM and RSC groups, of which 23.1% vs. 5.4% (p < 0.05) occurred within 3 months of surgery.ConclusionRSC is more beneficial and less invasive for patients with pelvic organ prolapse than TVM. In addition, de novo SUI as postoperative complication of RSC was lower than of TVM.

PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 May 2022PD44-08 POSTOPERATIVE OUTCOMES AFTER ROBOTIC SACROCOLPOPEXY WITH CONCURRENT RECTOPEXY IN WOMEN WITH MULTICOMPARTMENT PELVIC ORGAN PROLAPSE Shivani Gaitonde, Jessie Chen, Craig Olson, Philippe Zimmern, and Maude Carmel Shivani GaitondeShivani Gaitonde More articles by this author , Jessie ChenJessie Chen More articles by this author , Craig OlsonCraig Olson More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic assisted sacrocolpopexy (RSC) is an established surgical approach to correct pelvic organ prolapse (POP). However, relatively little data has been published regarding utilization of simultaneous rectopexy for patients with POP and defecatory dysfunction. The objective of this study was to describe outcomes of RSC with rectopexy versus RSC alone for patients with multicompartment POP. METHODS: Following IRB approval, we performed a retrospective analysis of women undergoing RSC with or without concurrent rectopexy at a single academic institution from December 2013 to May 2021. Pre- and postoperative demographics, pelvic organ prolapse quantification (POP-Q) score and assessment of defecatory dysfunction were reported. The primary outcomes were postoperative POP-Q Bp score, recurrence of symptomatic POP (POP-Q Ba or Bp>0) and need for additional POP surgery within 1yr. Secondary outcomes included complication rates and persistence of defecatory dysfunction. RESULTS: Of 162 women included in this study, 35 patients underwent combo RSC with rectopexy (22%) while the remainder underwent RSC only (n = 127, 78%). Mean age was 65yr (range 34-90) and BMI was 28.2 (range 19.4-51.4). Preoperative Bp (-1.5 in combo vs 0 in RSC-only), stage of posterior prolapse (mean stage 2 in both) and presence of external rectal prolapse (6% in both) did not significantly differ between groups. 71% of combo patients reported preop defecatory dysfunction vs 50% RSC-only patients. Mean postop follow-up was 23mo (range 1-82). Significantly more patients in the RSC-only group required repeat POP surgery within 1yr (0% combo vs 6% RSC-only, p < 0.05). The most common repeat surgery was posterior colporrhaphy (6/8 patients). However, by 1yr there were no differences in presence of symptomatic recurrent POP (5% combo vs 4% RSC-only) or reported defecatory dysfunction (34% combo vs 30% RSC-only). Median postop Bp was -3 in both groups. No intraoperative complications were noted in the combo group, while 3 patients in the RSC-only group had enterotomies repaired primarily. 2 combo patients had postoperative ileus managed conservatively (6%), and 2 had UTI (6%). 14 RSC-only patients had UTI (11%). CONCLUSIONS: Compared to RSC alone, combined RSC and rectopexy for women with multicompartment POP is associated with improved durability of posterior compartment repair without significant increase in adverse events. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e711 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shivani Gaitonde More articles by this author Jessie Chen More articles by this author Craig Olson More articles by this author Philippe Zimmern More articles by this author Maude Carmel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robot-assisted sacrocolpopexy for recurrent pelvic organ prolapse: Insights for a challenging surgical setting

Background: No consensus exists regarding the management of recurrent pelvic organ prolapse (POP). The aim of this study was to evaluate robot-assisted laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse (POP), and to investigate postoperative outcomes.Methods: We conducted a single-center retrospective study including 10 consecutive patients who underwent a robot-assisted sacrocolpopexy for symptomatic POP recurrence from February 2017 to December 2019. Recurrence rates and patient satisfaction, measured by the Pelvic Floor Impact Questionnaire (PFIQ-7) were recorded.Results: Median age was 57 years (IQR: 54–67). No intraoperative complications were reported. The median hospital stay after surgery was 2 nights (IQR: 1–4). Two patients (20%) experienced early recurrence: at 1 month for one and at 4.5 months for the other. The median follow-up for the remaining eight patients was 18 months (IQR: 12–23). Among the recurrence-free patients, the median PFIQ-7 score was 11.4 at 12 months.Conclusions: Robot-assisted sacrocolpopexy is feasible and safe for the management of POP recurrence, with a high patient satisfaction.

Single port robotic assisted sacrocolpopexy: technique and tips.

Sacrocolpopexy is the most durable surgical procedure for the treatment of symptomatic pelvic organ prolapse (Maher et al. Cochrane Database Syst Rev. 2013;(4):CD004014). The single port robotic platform has recently been approved in the USA for use in urological surgery. Innovation in robotic surgery continues to evolve, minimizing abdominal wall trauma while improving instrumentation and technical feasibility. Identifying the appropriate procedures to utilize novel technology is important to understand the role of new surgical tools. Sacrocolpopexy procedure, when performed with supracervical hysterectomy, requires extension of an incision for specimen retrieval, making it ideal for single port surgery. The technique and adaptation to new instrumentation is demonstrated in this video. A surgical demonstration of single port robotic sacrocolpopexy is shown. Sacrocolpopexy was successfully completed using the single port robotic platform. Sacrocolpopexy is technically feasible with use of the single port robotic platform.

Sacrocolpopexy experience with a novel robotic surgical platform.

The objective was to describe early experience performing sacrocolpopexy using a novel robotic surgical platform. This is a case series of all women who underwent robotic-assisted sacrocolpopexy using a new robotics platform (TransEnterix Senhance) between January 2019 and July 2021. All sacrocolpopexies were performed by a single Female Pelvic Medicine and Reconstructive surgeon at a large academic institution. Perioperative information including complications was abstracted from the medical record. Anatomical recurrence was defined as any anatomical point at or past the hymen (≥0). Data are descriptive, with Mann-Whitney U test used for comparison of operative time between the first and second half of the patients. A total of 25 sacrocolpopexies were performed using the new robotics platform. Mean age was 62.3 years (±9.2) and mean BMI was 26.5 (±3.8). Ten (40.0%) patients had a prior hysterectomy. Most (n = 21, 84.0%) had stage III or IV prolapse preoperatively. Mean operative time was 210.2 min (±48.6) and median estimated blood loss was 35 ml (IQR 25-50). Mean operative time decreased between the first and second half of the patients (231.7 min vs 190.3 min, p = 0.047). There were no major intraoperative complications. Median follow-up time was 16 weeks (IQR 4-34) and there were no subjective recurrences or retreatments during this period. Two patients (8.0%) had anatomical recurrence without subjective bother. There were two postoperative readmissions (8.0%) within 30 days for small bowel obstruction, one treated surgically and the other with nonsurgical management. Our case series demonstrates feasibility and successful early adoption of a new robotics platform for robotic sacrocolpopexy.

Robotic-Assisted Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Single Center Experience in China.

Objective The aim is to investigate the efficiency and outcome of robotic-assisted sacrocolpopexy (RASC) in a cohort of patients with pelvic organ prolapse (POP) in our Gynecology Department. Methods We performed a retrospective study of female patients who underwent RASC in Chinese PLA General Hospital from January 2013 to December 2020. Their clinical features included age, degree of prolapse, menopause time, body mass index, pregnancy, delivery, operation time, and bleeding volume. All patients were followed up for more than 6 months. POP-Q was recorded to evaluate the position of prolapsed organs. PFDI-20, PFIQ-7, and PGI-I were used to evaluate the life quality after surgery. Results Twenty-four patients with POP received RASC in our center. The intraoperative bleeding was 86.9 ± 98.3 ml (20–300 ml). The operation time was 143.5 ± 47.3 min (60–240 minutes). The hospitalization time was 10.4 ± 2.1 days (8–16 days). And the follow-up time was 40.8 ± 22.0 months (6–72 months). In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp, and C were significantly improved than those before surgery (P < 0.05). The objective and subjective cure rate was 100%. PGI-I score was very good in 9 (9/24), very good in 10 (10/24), and good in 3 (3/24). Postoperative PFDI-20 and PFIQ-7 were 2.78 ± 3.82 and 1.57 ± 3.86, which decreased dramatically after surgery (P < 0.05). Mesh exposure occurred in 4 cases (16.7%) at 2–12 months. The exposed diameters were less than 1 cm in 3 cases (2 A/T3/S1) and 1-2 cm in 1 case (3 B/T3/S1). These mesh exposures healed after conservative observation or mesh excision. Conclusion RASC for POP has the advantage of less bleeding and hospitalization time. It is a minimally invasive option for pelvic organ prolapse.

Robot-assisted sacro(hystero)colpopexy with anterior and posterior mesh placement: impact on lower bowel tract function and clinical outcomes at mid-term follow-up.

Background:Robotic sacrocolpopexy (RSCP) is an established option for the treatment of apical, anterior, and proximal posterior compartment pelvic organ prolapses (POP). However, there is lack of evidence investigating how lower bowel tract symptoms (LBTS) may change after RSCP.Methods:Data from consecutive patients treated with RSCP for stage 3 or higher POP from 2012 to 2019 at a single tertiary referral center with at least 1 year of follow-up were prospectively collected and retrospectively analyzed. RSCP was performed following a standardized technique which always employed both anterior and posterior hand-shaped meshes. Outcomes were collected at follow-up and analyzed. LBTS were evaluated through the Wexner questionnaire.Results:Overall, 114 women underwent RSCP. Eleven were excluded for missing data, whereas 12 had insufficient follow-up. Thus, 91 (79.8%) patients were included in this cohort. Median follow-up was 42 [interquartile range (IQR), 19–62] months. Mean age was 65 ± 10 years. In our series, RSCP was mainly performed for anterior and apical/medium stage 3 POP (in 95.6% of patients). Anatomic success rate of RSCP was 97.8%, with 89 patients with POP stage 0–1 at 12-month follow-up. Two patients (2.2%) experienced POP recurrence and were treated with redo-SCP. No patient experienced clinically significant posterior vaginal wall prolapse after RSCP. When analyzing LBTS, there was no significant change in postoperative total Wexner’s score as compared to the preoperative value (p > 0.05). However, the manual assistance subscore was statistically significantly lower within the first-year follow-up (p = 0.04), but it spontaneously improved during the follow-up (p = 0.12).Conclusion:RSCP with simultaneous placement of both anterior and posterior mesh is safe and successful to treat high-stage POP in carefully selected patients. Of note, LBTS appear unaffected by posterior mesh placement, supporting its routine use to prevent posterior POP recurrence. Larger prospective studies are needed to confirm our results.

An updated systematic review and network meta-analysis comparing open, laparoscopic and robotic-assisted sacrocolpopexy for managing pelvic organ prolapse.

Abdominal sacrocolpopexy is considered as the gold standard treatment for pelvic organ prolapse. Sacrocolpopexy can be performed using open (OSC), laparoscopic (LSC), and robotic-assisted (RSC) approaches. The aim of this study is to compare the outcomes between these three approaches for managing pelvic organ prolapse by conducting a systematic review and network meta-analysis. A systematic search was performed in different databases from their earliest records to April 2021 with no restriction on languages. Only randomized controlled trials that compared the outcomes between OSC, LSC, and RSC were included in this study. A total of 6 studies with 486 participants were included in this study. Operative time was significantly shorter in OSC than in RSC and LSC. The probability rank showed less estimated blood loss in RSC and lowest overall postoperative complications in LSC. Probability scores also showed best anatomical outcomes for postoperative points C and Bp in RSC and for point Ba in LSC. Despite significantly longer operative time, RSC and LSC may provide better anatomical outcomes, less estimated blood loss, and less overall postoperative complications than OSC. However, this study did not find significant differences between RSC and LSC in efficacy and safety.

A Novel, Structured Fellow Training Pathway for Robotic-Assisted Sacrocolpopexy.

We developed a novel fellow education pathway for robotic-assisted sacrocolpopexy (RASC) and aimed to compare step-specific and total operative times for RASC performed by Female Pelvic Medicine and Reconstructive Surgery (FPMRS) attendings with those in which FPMRS fellows performed part or all of the RASC. We further aimed to compare complication and readmission rates by fellow involvement. We tracked RASC at 1 institution between 2012 and 2018. We recorded times for total procedure, sacrocolpopexy, and 6 individual steps. Fellows were designated F1-F3 by training year. We used independent samples t-tests and analysis of variance for continuous variables and χ2 and Fisher's exact tests for categorical variables. Of 178 RASC procedures, 76 (42.7%) involved fellows. Concomitant procedures included hysterectomy (62.4%), midurethral sling (50%), and colporrhaphy/perineorrhaphy (51.7%). RASC without and with fellows had similar demographic, clinical, and procedural characteristics, except for midurethral sling rate (attending, 42.2% vs fellow, 60.5%; p = 0.02). RASC without and with fellows had similar times for total procedure (208.9 ± 61.0 vs 209.1 ± 48.6 minutes, p = 0.98), sacrocolpopexy (116.9 ± 39.9 vs 122.7 ± 29.2 minutes, p = 0.27), and all RASC steps except docking (attendings, 9.9 ± 8.6 vs fellows, 7.2 ± 7.0 minutes; p = 0.03). Complication rates and severity were similar without and with fellows. There were no readmissions. Our novel structured training program provides safe limitations for total and step-specific procedural times during fellowship education in RASC. Such training programs warrant further study to determine potential contribution to quality and safety in the teaching environment.

Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse?

Objective:To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse.Material and Methods:This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts.Results:Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures.Conclusion:Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.

Robot-assisted sacrocolpopexy: not only for vaginal vault suspension? An observational cohort study

Introduction and hypothesisSurgery for pelvic organ prolapse (POP) has high recurrence rates. Long-term anatomical and patient-reported outcomes after pelvic floor repair are therefore required.MethodsThis prospective observational cohort study was conducted in a teaching hospital with tertiary referral function for patients with POP. Patients with symptomatic vaginal vault or uterine prolapse (simplified POP Quantification [sPOPQ] stage ≥2), who underwent robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS), were included. Follow-up visits with sPOPQ evaluations were planned 4 years after surgery. Patients received pre- and postoperative questionnaires reporting symptoms of vaginal bulge, Urogenital Distress Inventory (UDI-6), and Pelvic Floor Impact Questionnaire (PFIQ-7). Primary outcome was patient self-reported symptoms. Secondary outcome was anatomical cure (sPOPQ stage 1) for all vaginal compartments.ResultsSeventy-seven patients were included. Sixty-one patients (79%) were evaluated after 50 months (physical examination n = 51). Symptoms of bulge (95% vs 15% p ˂ 0.0005), median UDI-6 scores (26.7 vs 22.2, p = 0.048), median PFIQ-7 scores (60.0 vs 0, p = 0.008), and median sPOPQ stages in all landmarks improved significantly from the pre- to the postoperative visit. Thirty patients (59%) were completely recurrence free and 96% of patients had no apical recurrence. Most recurrences were asymptomatic cystoceles (20%). There was one surgical re-intervention for recurrent prolapse (1.6%).ConclusionsRobot-assisted sacrocolpopexy and RSHS show sustainable results in the treatment of prolapse. Symptoms of bulge, urinary symptoms, and quality of life improved substantially 50 months postoperatively. Patients should be counseled about the risk of anterior wall recurrence and the small chance of recurrent symptoms that need treatment.

110 Long term follow up on barbed sutures in sacrocolpopexy

Apical pelvic organ prolapse (POP) is conventionally managed with abdominal sacrocolpopexy (SCP). However, due to its associated morbidities and longer recovery times, a minimally invasive approach via robotic-assisted sacrocolpopexy (RSCP) is gaining popularity with success rates of 87-100%. In addition, self-anchoring barbed sutures (SABs) has been introduced of suturing Y- shaped vaginal mesh in RSCP. This avoids knot tying with less time and aggravation. In our study, we demonstrated the long-term anatomical success and reoperation rates with SABs in RSCP. Under an IRB-approved protocol (IRB #19-0167), we retrospectively reviewed patients with symptomatic stage 2 or higher POP based on the Pelvic Organ Prolapse Quantification system (POP-Q) who underwent RSCP at a tertiary care academic medical center from January 2016 to October 2017. The placement of the Y-shaped vaginal mesh with 3-0 V Loc was consistent across all surgeries and performed by the same surgeon. Follow-up examinations were performed at intervals up to two years. Postoperative POP-Q scores <0 indicate anatomical correction without prolapse symptoms. Baseline demographics of patients were summarized by frequencies and percentages for categorical variables and by mean/median, standard deviation, and ranges for continuous variables. Descriptive univariate statistics were performed by SPSS Statistics. Fifty-five patients underwent RSCP with the mean age of 59.3 years. Seventeen patients were lost to follow-up and were excluded from the study. Of the 38 patients, the POP-Q system classified 28.9% with stage 2, 63.2% with stage 3 and 5.3% with stage 4 POP at baseline. A history of prior hysterectomy was noted in 55.3% of the patients and 31.6% of patients had a previous POP surgery. In our study, 42.1% underwent a hysterectomy with SCP, 18.4% a Burch urethropexy with SCP, 44.7 % a midurethral sling with SCP, and 5.3% of the patients solely underwent a sacrocolpopexy with no cases converted to open surgery. Our patients had an anatomical success rate of 86.8% with no mesh erosion on the 2-year postoperative follow-up. The complication rate was 7.9% due to intraoperative bladder injuries and were repaired primarily. Three patients had stage 2 prolapse and two patients had stage 3 prolapse on follow-up with a reoperation rate of 10.5%. of Our study suggests using RSCP with 3-0 SABs for vaginal wall mesh fixation as a favorable management for POP with low perioperative complication and reoperation rates.View Large Image Figure ViewerDownload Hi-res image Download (PPT)