One-Year Outcomes After Minimally Invasive Sacrocolpopexy

Abstract

Objective The primary aim of this study was to report anatomic, symptom, and quality of life outcomes in women with symptomatic stage 2 or greater prolapse 1 year after randomization to robotic and laparoscopic sacrocolpopexy. Methods This is a planned ancillary analysis of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies trial, a randomized comparative effectiveness trial comparing costs and outcomes of robotic and laparoscopic sacrocolpopexy at 2 academic medical centers. At baseline and 1 year after surgery, women underwent standardized assessment including validated subjective pelvic floor outcomes and physical examination with prolapse assessment. Results Sixty six (85%) of 78 randomized participants completed 1-year follow-up: 33 (87%) of 38 in the laparoscopic arm and 33 (83%) of 40 in the robotic arm (P = 0.59). Ninety-seven percent (32/33) in the laparoscopic group and 100% (33/33) in the robotic arm considered that their prolapse symptoms improved (P = 0.999). The cohort had significant improvement in all pelvic floor symptom and quality of life measures, which did not differ by treatment arm. Of women who were sexually active at 1 year, sexual function improved in both cohorts. No new serious adverse events, including mesh exposure or reoperation for prolapse, were identified between 6 months and 1 year after surgery. No women had a sacrocolpopexy mesh complication or reoperation for mesh exposure. Conclusions Minimally invasive sacrocolpopexy is associated with significant improvement in pelvic floor symptoms, anatomy, and sexual function. In addition, mesh exposure rates with lightweight polypropylene mesh seem to be lower than those reported with multifilament and heavier polypropylene mesh.

Sexual function after robot-assisted prolapse surgery: a prospective study

“…One study performed by Geller et al [ 8 ] investigated outcomes 1 year after RASC in 25 women with advanced POP and showed stable sexual function but no improvement after surgery. One randomized trial [ 23 ] compared LSC with RASC and showed an improvement in total PISQ-12 scores for both groups. The number of sexually active patients postoperatively was 14 and 15 in the two groups.…”

Research quality and transparency, outcome measurement and evidence for safety and effectiveness in robot-assisted surgery: systematic review

“…Using only the most recent time point of ‘long‐term follow‐up’ of primary outcomes for a given study population yielded 103 principal studies 14–116 for detailed analysis ( Table S1 , supporting information). There were 99 two‐arm studies (96·1 per cent) and four three‐arm studies (3·9 per cent), with a median of 78 (range 6–1516) patients.…”

Robotic Sacrocolpopexy for Treatment of Apical Compartment Prolapse

“…In studies with an average follow-up period of 6 months to 12 months, the cure rate of apical compartment prolapse ranges from 88%-100% [9][10][11][12][13][14][15], and in those with a follow-up period of 12-24 months, the cure rate ranges from 91.4%-100% [6,[16][17][18][19][20][21][22]. Even in long-term studies with over 5 years of follow-up, the cure rate is 93.3%-100%, indicating that RSC has excellent durability [23,24] (Table 2).…”

“…As shown in Table 1 , the objective cure rate of apical compartment prolapse was reported to be 88%–100% in 5 studies where RSC was performed only on patients suffering from vault prolapse after hysterectomy [ 13 , 15 , 16 , 24 ]. Among 12 studies in which RSC was performed on patients suffering from apical compartment prolapse irrespective of prior hysterectomy (excluding 4 studies where it was unclear whether the uterus was preserved or removed during RSC), 2 studies where the uterus was always preserved reported a cure rate of 100% [ 17 , 27 ], and 5 studies of concurrent supracervical hysterectomy in all patients reported cure rates ranging from 93.3% to 99.3% [ 11 , 12 , 14 , 23 , 25 ]. All other studies preserved the uterus or performed concurrent supracervical hysterectomy depending on the patient, with reported cure rates ranging from 94% to 100% [ 9 , 10 , 18 , 20 , 21 , 28 ].…”

“…The authors reported that the operative time for RSC was significantly longer, and that RSC was associated with more severe pain than LSC with no cost benefit. In a 2016 RCT involving patients with symptomatic apical POP of POP-Q stage 2 and above, Kenton et al [ 12 ] revealed in that both LSC and RSC patients showed significant improvement at the Ba, Bp, and C points during the 12-month follow-up period compared to before surgery. Illiano et al [ 17 ] recently reported the outcomes of an RCT of RSC (n=49) and LSC (n=51) in patients with POP-Q stage 3–4.…”