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abstract

159 - PROSPECTIVE ASSESSMENT OF ROBOTIC ASSISTED SACROCOLPOPEXY FOR THE TREATMENT OF PELVIC ORGAN PROLAPSE; A EUROPEAN BI-CENTRE COHORT (PARSEC).

159

PROSPECTIVE ASSESSMENT OF ROBOTICASSISTED SACROCOLPOPEXY FOR THE TREATMENT OF PELVIC ORGAN PROLAPSE; AEUROPEAN BI-CENTRE COHORT (PARSEC).

F. VAN ZANTEN1, O. E.O'SULLIVAN 2, S. SCHRAFFORDT KOOPS 1, B. A.O'REILLY 2;
1Meander Med. Ctr., Amersfoort,Netherlands, 2CUMH, Cork, Ireland.

Introduction: Whilst the use ofrobotics in the management of female pelvic organ prolapse (POP) isincreasing there is a paucity of data concerning efficiency andefficacy. Criticisms of RCT’s include the variance in surgeonexperience resulting in varying outcome measures such as wide rangesin operating time and complication rates.
Objective: Thepurpose of this prospective cohort study is to provide realisticoutcomes measures from different European centres with experiencedrobotic surgeons.
Methods: All consecutive patientsundergoing a Robotic procedure for uterovaginal prolapse from 2008until 2015 in two tertiary referral units in Europe were enrolled(N=501). All surgery was performed with the da Vinci Si-HD® byexperienced robotic laparoscopic urogynaecologists. For thesuspension a polyprolene mesh was used. The primary outcomes of thisstudy were the anatomic cure rates, safety of the procedure andintra-operative variables such as blood loss and operation time. Thesimplified Pelvic Organ Prolapse Quantification (POP-Q)1,was used to describe the anatomical cure after 1 year offollow-up.
Results: In total 501 patients were included.The median follow-up time was 14.0 months [range 8.0-44.4]. 68Patients were lost to follow-up (13.6%). Patient characteristics arelisted in table 1 and the operative data in table 2. Anatomicresults The median simplified POP-Q improved significantlyfor all four anatomic landmarks (table 3; p<0.0005).Intra-operative complications Twenty intra-operativecomplications were identified (4.0%), eight bladder lesions, of whichone resulted in a conversion and one had a concomitant conversion dueto adhesions. There were two small bowel serosa tears, which wererepaired intraoperatively. Eight surgeries were converted; one forbleeding from the presacral venous plexus, one due to ventilationproblems, one after a bladder lesion as above, three due to adhesionsand two for other reasons. One surgery was cancelled because ofventilation problems. The last complication occurred during a surgerywith massive adhesions, mesh placement on the anterior vaginal wallwas impossible; a small anterior wall colpotomy was made.Postoperative complications There were 38 (7.6%) earlypostoperative complications, most being small complications requiringno or a small intervention. Six (1.2%) patients had a severecomplication (Clavien Dindo Classification ≥3; table 4). Atfollow-up nine patients were identified with mesh erosion (1.8%) ofwhich two were exposed sutures (0.4%). Five patients requiredsurgical removal of the mesh or part of the mesh.

Table1. Patient characteristics.

Meanage (range)

60.2(32-91)

MeanBMI (range)

26.4(17.9-39.0)

Para,mean (range)

3.0(0-12)

Postmenopausal%

82.0

Previoushysterectomy

52.1

PreviousPOP/incontinence surgery

56.7


Table2. Operative data

Techniqueused, N (%)

  • Sacrocolpopexy

  • Sacrocervicopexy

  • Sacrohysteropexy

  • Cancellationof surgery

501

  • 261 (52.1)

  • 222 (44.3)

  • 17 (3.4)

  • 1(0.2)

Concomitantsurgery, N (%)

  • Rectopexy

  • TVT-O

  • Anterior and/orposterior colporrhaphy

  • Other

261(52.1)

  • 186 (37.1)

  • 20 (4.0)

  • 33 (6.6)

  • 30(6.0)

Meanblood loss, millilitres

52(0-1300)

Totalsurgery time, minutes

171(83-334)

Lengthof stay, nights, median

2(1-68)

Meanpain score, VAS

2.6(0-8)


Table3. Anatomic results

ShortPOPQ

Pre-operative,median

Post-operative,median

p-value

POPQ-A

3[1-4]

1.0[1-4]

P<0.0005

POPQ-B

2[1-4]

1.0[1-4]

P<0.0005

POPQ-C

3[1-4]

1.0[1-4]

P<0.0005

POPQ-D

2[1-4]

1.0[1-4]

P<0.0005


Table4. Complications and postoperative procedures

Intra-operativecomplications, N (%)

20(4.0)

Earlypostoperative complications; Clavien Dindo Classification. N (%)

  • Grade 1-2

  • Grade3-5

38(7.6)

  • 32 (6.4)

  • 6(1.2)

Postoperativemortality, N (%)

1(0.2; caused by severe pulmonary embolism)

Latepostoperative complications, N (%)

  • Mesh erosion, N(%)

  • Portsite herniation; expectant management

  • 9 (1.8)

  • 2(0.4)

Postoperativeprocedures

  • TVT-O

  • Anterior and/orposterior repair

  • Repair with mesh

  • Small externalrectal interventions

  • End colostomy

  • Other

  • 21 (4.2)

  • 7 (1.4)

  • 7 (1.4)

  • 16 (3.2)

  • 4 (0.8)

  • 18(3.6)


Conclusions: Currently thisis the largest prospective study assessing the robotic approach forprolapse. The results show the robot provides a safe, minimallyinvasive approach to apical prolapse, without increasing morbidity ormortality. The anatomic cure rates at one year show a significantimprovement. Furthermore, there is a reduced mesh erosion ratecompared to the vaginal route
References: 1. Swift S,Morris S, McKinnie V, et al. Validation of a simplified technique forusing the POPQ pelvic organ prolapse classification system. IntUrogynecol J Pelvic Floor Dysfunct. 2006;17(6):615-620.doi:10.1007/s00192-006-0076-z.