Robot-assisted Laparoscopic Sacrocolpopexy Research Articles

Postoperative complications and unanticipated healthcare encounters following mini-laparotomy vs. laparoscopic/robotic-assisted sacrocolpopexy: a comparative retrospective study

BackgroundPelvic organ prolapse is a debilitating condition impacting lives of millions of women worldwide. Sacrocolpopexy (SCP) is considered an effective and durable surgical technique for treatment of apical prolapse. The aim of this study was to compare short-term outcomes including postoperative complications and unanticipated healthcare encounters between patients who underwent SCP with a mini-laparotomy approach compared to patients treated with laparoscopic and robotic-assisted laparoscopic SCP.MethodsThis was a retrospective cohort study including patients treated for apical prolapse at a university affiliated urogynecology practice. Patients over the age of 18 who underwent abdominal SCP between 2019 and 2023 were included. The cohort was formed into two groups: (1) Patients who underwent SCP through a mini-laparotomy incision (Mini-lap group); (2) Patients who underwent laparoscopic or robotic-assisted laparoscopic SCP (Lap/Robot group).ResultsA total of 116 patients were included in the final analysis. Ninety patients underwent either laparoscopic or robotic-assisted SCP, whereas 26 patients underwent SCP with a mini-laparotomy approach. Study participants exhibited a mean age of 63.1 ± 10.3 years, mean body mass index (BMI) of 25.8 ± 4.9 Kg/m2, and 77.6% of them identified as Caucasian. Upon comparison of demographic and past medical history between groups there were no statistically significant differences in age, BMI, menopausal status, race, parity or comorbid conditions. Patients in the Mini-lap group were less likely to have undergone previous abdominal surgery (11.5% vs. 50.6%, p < 0.001) and had more severe apical prolapse (stage 4 prolapse, 40% vs. 21.2%, p < 0.001) than their counterparts in the Lap/robot group. Regarding intraoperative parameters, length of surgery was significantly shorter in the Mini-lap group compared to the Lap/robot group (97.3 ± 35.0 min vs. 242.0 ± 52.6 min, p < 0.001). When focusing on the primary outcome, postoperative complications within the first 30 days after surgery, there were no differences noted between groups. Additionally, the number of unanticipated healthcare encounters, such as phone calls, clinic visits, emergency department visits, urgent care visits, readmissions and reoperations were similar between groups.ConclusionsMini-laparotomy approach for SCP is safe with comparable intra- and postoperative complications, and unanticipated healthcare encounters compared to conventional minimally invasive methods.

Management of presacral hemorrhage during robotic-assisted laparoscopic sacrocolpopexy

Management of presacral hemorrhage during robotic-assisted laparoscopic sacrocolpopexy

Use of Novel Configuration with Suture Kit Device for Robotic-assisted Minimally Invasive Sacrocolpopexy

<h3>Study Objective</h3> To assess safety and efficacy of performing robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) using a four-arm robotic configuration and suture kit system. <h3>Design</h3> Retrospective case series. <h3>Setting</h3> Tertiary care referral center. <h3>Patients or Participants</h3> Patients undergoing RA-SCP with or without concomitant hysterectomy. <h3>Interventions</h3> All procedures were performed using four-arm robotic configuration and the Stitch Kit® polytetrafluoroethylene (PTFE) (Origami Surgical) suture kit device. The configuration included four 8 mm ports: one camera port and three working ports. No bedside assistant port was used. The Stitch Kit® PTFE, a canister with 6 polytetrafluoroethylene sutures and a separate compartment for used needles, was inserted into the abdominal cavity through a 8 mm umbilical skin incision prior to robotic docking. After suturing, each needle was replaced in the canister. The canister was closed and removed through the umbilical port site at the end of the case. No fascial closure of port sites was required. <h3>Measurements and Main Results</h3> 422 patients underwent RA-SCP for pelvic organ prolapse from 2018-2021. Mean age was 60 ± 10 years and mean BMI was 27 ± 6 kg/m². Most patients had stage III prolapse (73%) and underwent concomitant total hysterectomy (70%). 99% (n=416) of cases were completed robotically; of the 1% (n=6) not completed robotically, 5 had sacrospinous ligament suspensions due to presence of prior eroded foreign body material or extensive adhesions and 1 was aborted due to colorectal mass. The Stitch Kit® canister was successfully inserted and removed in all cases completed robotically with correct needle counts. 337 (80%) of participants followed up at 3 months. No umbilical or port site hernias were reported. <h3>Conclusion</h3> Our case series illustrates that RA-SCP can be performed safely using a four-arm robotic configuration with a suture kit device. This setup eliminates the need for any incisions greater than 8 mm and an assistant port. These modifications allow for surgical efficiency without compromising patient outcomes.

Predictors of persistent overactive bladder following surgery for advanced pelvic organ prolapse.

Reliable risk factors for persistent urgency following pelvic organ prolapse (POP) surgery are still unclear. We aimed to identify preoperative parameters related to persistent postoperative urgency in a cohort of women following surgery for POP stage 3-4 with concomitant overactive bladder (OAB). In this retrospective analysis, women with POP stage 3-4 and OAB who underwent POP repair during November 2012-December 2020 were included. Preoperative evaluation included history, Pelvic Organ Prolapse Quantification (POP-Q), multi-channel urodynamic studies and Pelvic Floor Distress Inventory (PFDI-20). Surgical procedures included: anterior and posterior colporrhaphy, sacrospinous ligament suspension, anterior vaginal wall mesh repair and robotic-assisted laparoscopic sacrocolpopexy. At the 12-month follow-up, urogynecological history, POP-Q evaluation, cough stress test and the PFDI-20 questionnaire were repeated. One hundred seventy-three patients were included in the analysis. Resolution of urgency was observed in 56% of women. Variables associated with persistent postoperative urgency included body mass index (BMI) (27 kg/m2 vs 25.7 kg/m2, p = 0.04), preoperative increased daytime frequency (46.39% vs 61.84%, p = 0.05), urgency urinary incontinence (UUI) (51.46% vs 80.26%, p = 0.0001), detrusor overactivity (DO) (40.2% vs 61.84%, p = 0.009) and lower maximum flow rate on UDS (13.9 ml/s vs 15 ml/s, p = 0.04). Multivariate analysis confirmed preoperative DO (OR: 12.2 [95% CI: 1.4-16.6]; p = 0.01), preoperative UUI (OR 3.8 [95% CI: 1.3-11.0]; p = 0.008) and BMI > 25 kg/m2 (OR 1.8 [95% CI: 1.1-7.2]; p = 0.04) as predictive factor for persistent urgency. In women with advanced POP and OAB, being overweight, preoperative UUI and DO are related to persistent postoperative urgency. These findings will guide our future preoperative counseling and reinforce the role of UDS in POP management.

V06-02 SINGLE PORT ROBOTIC ASSISTED LAPAROSCOPIC SACROCOLPOPEXY: NEW FRONTIER IN MINIMALLY INVASIVE ABDOMINAL REPAIR OF PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 May 2022V06-02 SINGLE PORT ROBOTIC ASSISTED LAPAROSCOPIC SACROCOLPOPEXY: NEW FRONTIER IN MINIMALLY INVASIVE ABDOMINAL REPAIR OF PELVIC ORGAN PROLAPSE David Ali, Mubashir Billah, and Mutahar Ahmed David AliDavid Ali More articles by this author , Mubashir BillahMubashir Billah More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The da Vinci Single-Port robotic system (SP) was approved by the Food and Drug Administration for use in urologic procedures in 2018 and since, its implementation has become widespread. This case series highlights the feasibility and surgical technique when performing sacrocolpopexy using the SP system. METHODS: We reviewed cases of SP robotic sacrocolpopexy performed by a single surgeon at a single institution. RESULTS: N=4 patients underwent SP robotic sacrocolpopexy. Mean operative time was 86 minutes. Mean estimated blood loss was 55 milliliters. All patients were discharged home on post-operative day one and no complications were noted. CONCLUSIONS: SP sacrocolpopexy is a feasible alternative to multiport sacrcolpopexy. With fewer incisions, single port surgery potentially enables less post-operative pain and improved cosmesis. Single port surgery has an associated learning curve and limitations that warrant further evaluation. We observed that the SP system is better suited for small to medium size uteruses given the limited grip and movement strength of the SP instruments. Further comparison to multiport sacrcolpopexy is ongoing at our institution. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e565 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ali More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed 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.

The impact of body mass index on perioperative outcomes following robotic sacrocolpopexy

Robotic-assisted minimally invasive surgery (RAMIS) has proven benefits amongst the obese population. 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 stratify patients of varying body mass index (BMI) in order to ensure optimal outcomes in those undergoing RA-SCP for POP repair.

Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy

To assess the outcome of robotic-assisted laparoscopic sacrocolpopexy (RALSCP) and to identify risk factors for surgical failure and long-term complications in patients at high risk for surgical failure. Retrospective cohort study. A university hospital. Sixty-seven women with pelvic organ prolapse (POP) at high risk for surgical failure. RALSCP from November 2012 to July 2020. Information was collected from the electronic medical records. Preoperative and postoperative assessment included urogynecologic history, prolapse staging, cough stress test, and validated quality of life questionnaires. Anatomic success was defined as POP stage < 2 at the last follow-up. Mean follow-up was 24.6 ± 17.9 months. Sixteen women (23.9%) reported bulge symptoms at the latest follow-up; upon POP Quantification staging, surgical failure or recurrence was observed in 35 patients (52.2%). On multiple logistic regression analysis, a preoperative POP Quantification point Ba measurement ≥3 cm beyond the hymen was independently related to surgical failure. Late postoperative complications included 3 cases (4.5%) of postoperative ventral hernia and 5 cases (7.5%) of mesh erosion, all in patients operated using Ethibond sutures. Anatomic success of RALSCP in POP patients at high risk for surgical failure is worse than previously reported. Advanced preoperative anterior vaginal wall prolapse is a risk factor for surgical failure. Delayed absorbable sutures for vaginal mesh fixation seem to be safer than multifilament, permanent sutures, in terms of the risk of mesh erosion.

Perioperative Outcomes Following Opportunistic Bilateral Salpingo-Oophorectomy at the Time of Sacrocolpopexy

<h3>Study Objective</h3> Surgeons commonly opt to perform an opportunistic bilateral salpingo-oophorectomy (BSO) for peri- and postmenopausal women who undergo pelvic reconstructive surgery (PRS) in order to prevent future development of malignancy. The prevalence of underlying gynecologic malignancy amongst this population is not well defined in medical literature. There is also limited information on the impact of an opportunistic BSO on perioperative outcomes. This study aims to investigate the oncologic incidence and perioperative outcomes for those undergoing robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) for pelvic organ prolapse (POP) with and without a concomitant BSO. <h3>Design</h3> Retrospective descriptive analysis. <h3>Setting</h3> University-affiliated community hospital. <h3>Patients or Participants</h3> Cases of patients who underwent a RA-SCP without hysterectomy (n=283) by one surgeon between March 2017 and March 2020. <h3>Interventions</h3> RA-SCP with concomitant BSO (n=150) versus without BSO (n=133). <h3>Measurements and Main Results</h3> A total of 2 patients (0.7%) were found to have malignant adnexal pathology: 2 high grade serous cancers of the fallopian tube with no ovarian cancers detected. Cases with concomitant BSO required statistically significant longer operative times (215 vs 197 mins, p<0.05). Morphine milligram equivalents (MME) used in the post-anesthesia care unit (PACU) and the recovery floor were comparable between with and without BSO groups (2.95 and 20.09 MME, vs 3.14 and 22.55 MME, p=0.59, p=0.49), respectively. Quantitative blood loss was similar amongst both groups (-2.12 and -2.31 g/dL, p=0.08). Demographics were without statistical differences between groups. <h3>Conclusion</h3> Performing opportunistic BSOs at the time of PRS with a RA-SCP is a well-tolerated procedure. A small subset of patients were found to have gynecologic cancer. Surgeons should counsel patients regarding the safety profile of opportunistic BSO and the potential to detect cancer in patients with POP who otherwise have no suspicion for adnexal malignancy.

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

<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.

A Descriptive Analysis of Occult Gynecologic Malignancy in a Large Series of Supracervical Hysterectomy with Sacrocolpopexy

<h3>Study Objective</h3> The incidence of occult malignancy in patients with pelvic organ prolapse (POP) undergoing a supracervical hysterectomy (SCH) at the time of robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) is not well documented in the medical literature. This has clinical implications as discovery would entail further operative management to perform staging, remove oncologic burden, and possibly revise the approach to pelvic reconstructive surgery. This study aims to detect the prevalence of oncologic pathology and ability of diagnostic preoperative work-up to detect such disease. <h3>Design</h3> Retrospective descriptive analysis. <h3>Setting</h3> University-affiliated community hospital. <h3>Patients or Participants</h3> All women undergoing a RA-SCP with SCH by one surgeon between March 2017 and March 2020 without symptoms of abnormal or postmenopausal bleeding. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 425 women were included in this study. Of these, 19 (4.2%) patients were found to have uterine pathology of either pre-malignancy (n=14, 3.5%) or malignancy (n=5, 1.2%). Transvaginal ultrasonography (TVUS) had lower cases of missing pathology compared to EMB in the case of endometrial cancer (EC) (0% vs. 1.2%), endometrial hyperplasia +/- atypia (EH) (2.4% vs. 3%), or in combination EC and EH (2.4% vs 4.2%). EC and EH collectively were undiagnosed by either TVUS or EMB until final pathology in 4.2% of cases. <h3>Conclusion</h3> A small subset of asymptomatic postmenopausal women who undergo a SCH at the time of RA-SCP for POP will have underlying gynecologic malignancy or premalignant conditions. EMB or TVUS in these patients have inadequate sensitivity to rule out endometrial pathology and patients should be counseled appropriately regarding the small but possible necessity to remove the cervix in its entirety. Patients may be offered an intraoperative pathology assessment of the SCH prior to attachment of SCP mesh material to the cervix when appropriate.

Single-Incision vs. Multiport Robotic Sacrocolpopexy: 126 Consecutive Cases at a Single Institution.

Robot-assisted laparoscopic sacrocolpopexy (RSC) has gained popularity as a method for easier intracorporeal suturing than conventional laparoscopic sacrocolpopexy. However, few studies have compared multiport RSC (MP-RSC) and single-incision RSC (SI-RSC). We aimed to compare perioperative outcomes between these techniques for advanced pelvic organ prolapse (POP). We analyzed 126 patients who underwent RSC for POP quantification (all stage III to IV) between March 2019 and May 2021 at Seoul Asan Medical Center. We prospectively collected operation-related data, including total operation time (OT; from skin incision to closure) and perioperative outcomes. A total of 106 and 20 patients underwent MP-RSC and SI-RSC, respectively. The mean ages were 57.49 ± 10.89 and 56.20 ± 10.30 years in the MP-RSC and SI-RSC groups, respectively. The mean total OT was significantly shorter for MP-RSC than for SI-RSC (105.43 ± 24.03 vs. 121.10 ± 26.28 min). The OT difference was 15.67 min (95% confidence interval, 3.90–25.85, p = 0.009). No statistically significant differences were observed in terms of perioperative variables (estimated blood loss, hospital stay) and postoperative adverse events (POP recurrence, mesh erosion). SI-RSC had comparable intraoperative and postoperative outcomes to MP-RSC, with additional cosmetic benefits. MP-RSC had significantly shorter OT than SI-RSC.

Comparing the outcomes and effectiveness of robotic-assisted sacrocolpopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.

Abdominal sacrocolpopexy is regarded as the gold standard for management of pelvic organ prolapse (POP). Nowadays, minimally invasive surgeries are preferred, and sacrocolpopexy can be performed using either a laparoscopic or robotic-assisted approach. The aim of the current study was to compare the efficacy and safety of robotic-assisted sacrocolpopexy (RASC) and laparoscopic sacrocolpopexy (LSC) through an updated systematic review and meta-analysis. We performed a systematic literature review of different databases and related references from their inception until July 2020 without language restrictions. All randomized control trials and comparative studies that compared RASC and LSC for the management of POP were included. A total of 13 studies including 2115 participants were included for the pooled analysis. The pooled results revealed that RASC was associated with a significantly longer operative time (weighted mean difference, 29.53min; 95% confidence interval [CI], 12.88 to 46.18min, P = 0.0005), significantly less estimated blood loss (weighted mean difference, -86.52ml; 95% CI -130.26 to -42.79ml, P = 0.0001), significantly fewer overall intraoperative complications (odds ratio [OR] 0.6; 95% CI 0.40 to 0.91; P = 0.01) and significantly lower conversion rate (OR 0.39; 95% CI 0.19 to 0.82; P = 0.01) compared with LSC. There were no significant differences between the length of hospital stays, overall postoperative complications, postoperative stress incontinence, mesh erosion and effectiveness between the two groups. The current study showed comparable efficacy between RASC and LSC. Though RASC was associated with less blood loss and a lower conversion rate, the differences were not clinically significant. The choice of surgical procedure with either RASC or LSC is according to surgeon discretion and patient preferences.

A prospective randomized trial comparing Restorelle® Y mesh and flat mesh for laparoscopic and robotic-assisted laparoscopic sacrocolpopexy: 24-month outcomes.

To compare prolapse recurrence and the incidence of mesh exposure between Restorelle® Y mesh and dual flat mesh. A randomized trial of women undergoing laparoscopic (LSC) or robotic (RSC) sacrocolpopexy for post-hysterectomy vaginal prolapse. Subjects were randomized to either Y mesh or dual flat mesh. Subjects underwent a pelvic examination with POP-Q and evaluation of any mesh exposure, and the PFDI-20 was administered at 6, 12 and 24months postoperatively. Subjective recurrence was defined by symptomatic vaginal bulge. All subjects underwent pelvic examination with POP-Q at 6, 12 and 24months. Objective recurrence was defined by descent of the apex > 1/3 into the vaginal canal, anterior or posterior vaginal descent beyond the hymen, or retreatment for prolapse. Sixty-two patients were enrolled, and 59 patients were implanted with mesh: 30 Y mesh (17 LSC, 13 RSC) and 29 flat mesh (18 LSC, 11 RSC). There were no differences in patient characteristics between the groups. At 24months, data were available for 44 (74.5%) patients. There were no mesh exposures for all subjects. PFDI-20 scores improved significantly for all subjects with no differences in mean improvement by mesh configuration. There were no differences in subjective and objective recurrence rates between the groups. Four patients (9.1%) complained of subjective vaginal bulge symptoms while nine (20.5%) patients had an objective recurrence (77.8% [7] examination only and 22.2% [2] reoperation). There were no apical recurrences. Of those patients who had a recurrence on examination only (n = 7), 85.7% (6) were asymptomatic. At 24months, there were no differences in subjective outcomes and prolapse recurrence in patients who underwent sacrocolpopexy with the Restorelle® Y mesh versus dual flat mesh. One in five patients experienced an objective recurrence; however, there were no apical recurrences and the majority were asymptomatic.

Tips for Performing a Combined Robotic Assisted Sacrocolpopexy and Ventral Rectopexy

Study Objective In this video we highlight our technical tips for performing a combined robotic sacrocolpopexy and ventral rectopexy for concomitant posterior, middle and anterior compartment prolapse. Design Video submission. Setting Collaboration between FPMRS and Colorectal Surgery specialists in a community teaching hospital. Patients or Participants 55 year-old G1P1 overweight female s/p laparoscopic hysterectomy and bilateral oophorectomy for endometriosis presenting with severe obstructed defecation syndrome (ODS) and incomplete bladder emptying. On exam she had a grade 2 rectocele, a grade 1 vault prolapse, and a grade 2 cystocele. She scored 22 points on a KESS constipation questionnaire. A 3D transvaginal/transrectal and translabial ultrasound showed a grade 3 rectocele, enterocele causing rectal intussusception and a cystocele that descended below the pubic bone. Interventions For the robotic surgery the patient was positioned in dorsal lithotomy and maximum Trendelenburg. She underwent a combined robotic assisted laparoscopic sacrocolpopexy with polypropylene mesh and ventral rectopexy with cross linked porcine dermis mesh. Measurements and Main Results Preoperative and 3 months postoperative 3D transvaginal/ transrectal and translabial ultrasounds, KESS constipation questionnaire, PFDI-20, and PFIQ-7. Three months after her surgery her ODS symptoms have resolved, her KESS score dropped from 22 to 12 points, and on repeat ultrasound she had no residual pelvic prolapse, no obstruction on straining and no cystocele. Conclusion For patients with vaginal vault prolapse, cystocele, and rectocele a combined sacrocolpopexy and ventral rectopexy can be an effective surgical intervention.

Therapeutic effect of robot-assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.

To assess short-term functional outcomes achieved by robot-assisted sacrocolpopexy for pelvic organ prolapse. We retrospectively collected clinical and operative data for female patients who underwent either pure laparoscopic sacrocolpopexy (a control group, n=20) or robot-assisted laparoscopic sacrocolpopexy (a study group, n=20) between December 2017 and December 2018. The clinical indicators included age, gestational age, parity, the stage of pelvic organ prolapse. Perioperative data included operative time and total blood loss. Post-operative outcomes included hospital stay, the time of detaining urethral catheterization, and the restart of anal exhaust after surgery. At the same time, complications and quality of life were observed till 6 months after the surgery. There were no definitely differences in the perioperative data between the 2 groups. It is worth mentioning that robot-assisted laparoscopic sacrocolpopexy was superior in strict operative time. With a follow-up of 6 months, the study group's anatomic repair rate was 100% (20/20), while the control group was 95% (19/20). Pelvic Floor Distress Inventory-short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short Form 7 (PFIQ-7) were used to evaluate patients' quality of life. There was no significant difference in the scores between the study group and the control group before and 6 months after surgery. Only the data of the PFDI-20 questionnaires at 1 month after operation were statistically significant, and in the control group was larger than that in the study group, showing that robotic surgery can recover faster than laparoscopy, and the quality of life can be improved quickly. Robot-assisted laparoscopic sacrocolpopexy is a safe and reliable technique, faster than laparoscopy in recovery and has a short-term effect.

Surgical technique of robot-assisted laparoscopic sacrocolpopexy

: Comparing to the laparoscopic approach, robotic surgery provides many advantages, facilitating the operating process, improving results and making it more comfortable for the surgeon. Sacrocolpopexy (SCP) is the most beneficial technique for apical prolapse, despite its complexity, so the robot’s assistance could make it more convenient. Steps of SCP are the following: (I) peritoneal opening with further mobilization of the longitudinal presacral ligament, mm. pubococcygeus, perineal body, posterior and anterior vaginal walls. Subtotal hysterectomy should be done if the uterus is present. (II) Fixation of the posterior part of the mesh to mm. levator ani, perineal body, the posterior vaginal wall, and vaginal cuff or cervix. Fixation anterior part of the mesh to the anterior vaginal wall and vaginal cuff or cervix. (III) Fixation of the mesh to the longitudinal presacral ligament in the area of promontorium. (IV) Peritoneal closure and vaginal packing. From January 2013 to December 2019, 181 patients underwent RA SCP in our department. Long-term assessment (more than 1 year) was made in 74 patients. There weren’t found graft-related complications requiring additional surgery. Seventy (94.6%) of patients claimed excellent and good subjective results showing improvement in scoring using pelvic organ prolapse questionnaires. Sixty-one (82.4%) showed good and excellent anatomical results showing an absence of prolapse or stage I prolapse recurrence. However, 13 (17.6%) patients showed recurrent II–III stage of cystocele. RA SCP is the operation of choice in sexually active women with apical prolapse. Robotic surgery has advantages comparing laparoscopic approach in obese patients, women with dense or strong intraabdominal adhesions, recurrent pelvic organ prolapse after laparoscopic or vaginal mesh repair.

Long-Term Outcomes of Robotic-Assisted Laparoscopic Sacrocolpopexy Using Lightweight Y-Mesh

The objective of this study was to describe anatomic and symptomatic outcomes at 5 years or longer after robotic-assisted laparoscopic sacrocolpopexy using very lightweight polypropylene Y-mesh. A prospective analysis of consecutive patients who underwent surgery at a single center between 2007 and 2011 was performed. Patients consented to objective and subjective assessment at 5 years or longer postoperatively. Surgical success was defined as meeting all of the following: (1) no retreatment for pelvic organ prolapse (POP) since surgery, (2) no prolapse beyond the introitus, (3) no apical descent below -5, and (4) no prolapse symptoms reported. Secondary outcome measures included Sandvik Incontinence Severity Index, the PFDI-20, the PFIQ-7, the PISQ-12, and the SSQ-8), rates of dyspareunia, mesh complications, and subjects' need for any surgical or nonsurgical prolapse treatment since their index surgery. Eighty percent of the potential study group (253/316) presented for examination and subjective assessment at 5 years or longer after their index surgeries.The surgical success rate was 226 (89.3%) of 253 with no apical failures. Only 4.4% (11/253) of the group met both objective and subjective failure criteria. Sixteen patients were classified as surgical failure owing to subjective criteria alone despite having no significant objective prolapse on examination. Ten patients (4%) elected to undergo subsequent POP repair. These operations consisted of 5 native tissue anterior repairs and 5 native tissue posterior repairs. In addition, 1 patient elected to use a pessary for recurrent anterior POP. The remaining 16 patients who experienced surgical failure elected no further prolapse treatment. Robotic-assisted laparoscopic sacrocolpopexy using very lightweight mesh provided excellent long-term results with no mesh-related complications.

Single-port robotic-assisted laparoscopic sacrocolpopexy with magnetic retraction: first experience using the SP da Vinci platform.

The purpose of this study was to describe technical considerations and first outcomes from a single-port robotic-assisted sacrocolpopexy (RSC) using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA) and the Levita™ Magnetic Surgical System (San Mateo, CA, USA), a novel magnetic retraction system. Three females with pelvic organ prolapse elected to undergo RSC using the da Vinci SP platform. The supraumbilical incision length was 25mm through which SP trocar was placed. A 12-mm assistant port was placed in the right upper quadrant. The external magnet was attached to the left side of the bed and used for bowel and bladder retraction. We then proceeded by duplicating the steps of our approach for a RSC performed using a multi-port robotic platform with necessary modifications given the SP approach. Intra-operative outcomes and peri-operative outcomes were collected and reported. The patients were women of 64, 66 and 73years of age with BMI of 22, 25, and 34, respectively, and POP-Q stage III and IV prolapse. The RSC was performed between 198 and 247min, estimated blood loss was 10-50cc, and there were no complications. All patients were discharged home on post-operative day 1. All patients were doing well 1 month out with resolution of bulge symptoms. To our knowledge, this represents the first case series of robotic, magnetic-assisted sacrocolpopexies using the da Vinci SP platform and the Levita™ Magnetic Surgical System. It appears to be a safe and feasible approach, but long-term comparative studies will be necessary to assess functional outcomes.

Robotic-assisted laparoscopic sacrocolpopexy: Initial Canadian experience

Abdominal sacrocolpopexy provides effective long-term outcomes for apical pelvic organ prolapse. The introduction of robotic-assisted laparoscopic sacrocolpopexy (RALS) has mitigated the risks of abdominal surgery. This study aims to evaluate the preoperative patient characteristics, intraoperative surgical parameters, and postoperative outcomes of RALS, which has not been previously performed in Canada. A retrospective chart review of 47 patients who have undergone RALS from 2016-2018 by a single surgeon at a tertiary care hospital in Canada was completed. This case series had a mean age of 60.2 years, body mass index (BMI) of 28.3 kg/m2, and Charlson comorbidity index of 2.0. Preoperatively, 13 (28%), 23 (49%), and 11 (23%) patients had Baden-Walker grade 2, 3, and 4 apical prolapse, respectively. Intraoperatively, 45 (96%) patients underwent concomitant procedures, including 36 (77%) with adnexal surgery, 32 (68%) with anti-incontinence surgery, and 25 (53%) with hysterectomy. Intraoperative complications included one ureteric injury, two bladder injuries, and three vaginotomies. The mean robotic console time, surgery time, and total operating room times were 125.6, 148.6, and 190.6 minutes, respectively. Postoperatively, data was analyzed for 32 (68%) patients with greater than 12 weeks' followup. There was no recurrence of apical prolapse on exam after a mean followup of 60.1 weeks. Seven (22%) patients experienced symptomatic prolapse in the posterior compartment. There were two grade 3 Clavien-Dindo complications, including osteomyelitis and mesh exposure. RALS can be safely and effectively performed with other pelvic procedures with good outcomes. Concurrent posterior repairs may be considered in select patients.