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Robot-Assisted Laparoscopic Sacrocolpopexy in Patients with Prior Transvaginal Repair of Pelvic Organ Prolapse
Farshid Hajimirzaee, M.D.1, Jennifer Yates, M.D.2, Mutahar Ahmed, M.D.1, Susan Rusnack, M.D.1, Debra Fromer, M.D.1, Greg Lovallo, M.D.1.
1Hackensack University Hospital, Hackensack, NJ, USA, 2University of Massachusetts, Worcester, MA, USA.

Introduction: Robotic sacrocolpopexy (RALSC) has grown in popularity, with robotic assistance providing excellent visualization in the pelvis, and instrument mobility to facilitate the dissection and mesh manipulation. The role of RALSC in patients who have undergone prior transvaginal pelvic floor reconstruction (PFR) has not been well-defined.
Methods: All patients undergoing RALSC by Urologists at a single institution between 2008 and 2012 were included in the study. A retrospectively-maintained database was reviewed for relevant perioperative variables.
Results: A total of 67 patients underwent RALSC. Of these patients, 11 had undergone prior transvaginal PFR. The mean age of the patients was 58 years, mean parity was 2.8, and mean ASA was 2.1. Mean degree of apical prolapse was grade 3.5. Eighty-two percent were sexually active at the time of initial evaluation. Twenty-seven percent underwent concomitant transvaginal urethral sling procedure. There was one Clavien grade II complication, which was a pelvic abscess requiring long-term intravenous antibiotics. The mean total operative time was 149 minutes. Mesh erosion into the vagina did not occur in any of the cases. At a mean follow-up of 12.5 months (range 2-29), grade I apical prolapse was noted in two patients (18%), both of whom were asymptomatic.
In comparison, the mean apical prolapse in patients without a history of PFR was grade 3.2. These patients experienced 3 Clavien grade II complications. Mesh erosion did not occur in any of these patients. Grade I to III apical prolapse recurred in 14 patients, at 17.9%, 5.4% & 1.8%, respectively. None of these patients were symptomatic.
Conclusions: RALSC can be safely performed in patients who have undergone prior transvaginal PFR. The complication rate is comparable to that of patients undergoing RALSC without prior PFR. Symptomatic apical prolapse occurred in one patient in the prior PFR group.
Demographic and perioperative data
Prior Transvaginal Repair (Mean)No Prior Transvaginal Repair (Mean)
Mean Age58.165.6
Mean Degree of Prolapse3.43.2
% Sexually Active82%53.70%
Operative Time (min)149.5136.5
EBL (cc)98.3101.9
Follow Up (months)12.515.8

Post-Surgical Prolapse Recurrence
Prior Transvaginal RepairNo Prior Transvaginal Repair
Grade 1 Prolapse (%)1817.9
Grade 2 Prolapse (%)05.4
Grade 3 Prolapse (%)01.8

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