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Robotic Assisted Laparoscopic Sacrocolpopexy: Analysis of Complications, Objective and Subjective outcomes
Paholo G. Barboglio Romo, MD, MPH1, Andrew W.J. Toler, MS2, Veronica Triaca, MD3.
1Dartmouth-Hitchcock, Lebanon, NH, USA, 2The Dartmouth Institute, Hanover, NH, USA, 3Conocord Urology, Concord, NH, USA.
BACKGROUND: The aim of our study was to assess the mesh complication rate at our institution, as well as investigating complication rates for other major post-operative complications. Secondly, to analyze patient’s subjective and objective outcomes at one year from surgery in order to investigate predictors of improvement failure in women’s symptoms.
METHODS: IRB Approved, single site retrospective cohort study of 131 women undergoing robotic assisted laparoscopic sacrocolpopexy (RALS) for symptomatic apical POP from May 2010 to August 2012. Initial history, physical examination, diagnosis and follow up were performed by single surgeon (VT). Symptoms (subjective) data were obtained from self-reported validated questionnaires and its subcategories: Short version of the Pelvic Floor Inventory (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20). Baden-Walker grading system was used to evaluate objective data. We established a strict improvement of >70% on questionnaire’s total score to determine “clinical improvement”. Continuous data were analyzed using student’s t-test and categorical data via the Pearson Chi Square test, Wilcoxon sum ranks test and Kruskal-Wallis multiple comparisons.
RESULTS: A total of 127 women with six months follow up were identified to assess complications rates. Mesh erosion occurred in three patients (2.4%) and they all improved with conservative methods. Other complications reported were bowel injury (2.4%), readmission rate (2.4%), wound infection (1.6%) and post-operative hernia at port site (1.6%). Complete one year follow up data was available for 92 women and although there was no persistent apical prolapse at one year, anterior prolapse was present in 7 patients. Clinical improvement was present in 72% by PFIQ-7 and in 68% by PFDI-20. Women with no clinical improvement were older (p=0.04), had >2 pregnancies (p=0.03), concomitant lysis of adhesions (p=0.003).
CONCLUSIONS: RALS represents a safe and effective surgical therapy to manage symptomatic apical POP. Although serious complications, including mesh erosion are very low, the implications on quality of life outcomes are variable.
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