COMPLICATION RATE ON THE LEARNING CURVE OF LAPAROSCOPIC SACRAL (HYSTERO-)COLPOPEXY
BLAGANJE1, K. DRUSANY STARIČ 1, A. LUKANOVIC 1, B. DEVAL 2;
1DIVISION OF GYNECOLOGY, UNIVERSTY Med. CENTRE LJUBLJANA, LJUBLJANA, Slovenia, 2GEOFFROY SAINT HILAIRE CLINIC, PARIS, France.
Introduction: Laparoscopic sacral (hystero-)colpopexy (LSC) has become an established surgical technique, which provides excellent reconstructive outcomes for patients with pelvic organ prolapse (POP) and as such is gaining popularity. While in many centers this minimally invasive approach is the preferred way of treating prolapse, there are only initial attempts towards its implementation in others. With increasing concerns of patients safety, complication rate with implementation of a new surgical approach is one of the main concerns.
Objective: Objective was to assess intraoperative and immediate postoperative complication rate with initial LSC procedures at our unit.
Methods: After being intraoperatively trained according to steps (1.) by demonstration and performance of the entire procedure under supervision of an expert 2 - 3 times, two laparoscopic gynecological surgeons performed 66 cases in 15 months. All intraoperative and immediate postoperative complications were recorded together with anatomic result 8 weeks after surgery and screened for recurrence at 16-week and 1-year follow-up.
Results: Complication rates for the initial 66 LSC cases are presented in the tables below, separately for intraoperative and postoperative complications. All complications occurred in initial 15 cases and none later along the learning curve. The most common was bladder injury. All patients presented with satisfactory anatomic result 8 weeks after surgery (prolapse of any compartment ≤ stageI). All 3 recurrent cases identified at 16-weeks or 1-year were in complex patients (1 following surgery in a patient after bladder extrophy, 1 apical prolapse following 4 previous prolapse operations, 1 cystocoelae following 4 previous prolapse operations).
Conclusions: With initial 66 cases of LSC performed by two laparoscopic surgeons the occurrence of all complications and severe complications didn`t exceed that of large volume reported in different registries. Complication incidence was noted with surgeons initial few procedures, but not later.
References: 1. Int Urogynecol J. 2016; Jul;27(7):1117-9. doi: 10.1007/s00192-016-2960-5. PubMed PMID: 26886552