Perioperative Outcomes, Complications, and Efficacy of Robotic-Assisted Prolapse Repair: A Single Institution Study of 196 Patients

Gupta, Priyanka; Ehlert, Michael; Bartley, Jamie; Gilleran, Jason; Killinger, Kim A.; Boura, Judith; Nagaraju, Pradeep; Fischer, M

doi:10.1097/spv.0000000000000472

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…There have been several studies assessing results after robotic sacrocolpopexy. 10,13,14 Gupta and colleagues showed only two apical recurrences in 196 women undergoing robotic prolapse repair, with a mean follow-up time of 9 months. 13 Other studies, too, have shown improvement in QOL scores using the PFDI and the PFIQ.…”

Section: Discussionmentioning

confidence: 99%

“…10,13,14 Gupta and colleagues showed only two apical recurrences in 196 women undergoing robotic prolapse repair, with a mean follow-up time of 9 months. 13 Other studies, too, have shown improvement in QOL scores using the PFDI and the PFIQ. 14–18 In a recently published study by Jong and colleagues, following robotic mesh sacrocolpopexy of 56 women with a mean follow-up time of 3 years, mean AUA QOL score improved significantly from a mean of 4–1.78 postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes

Vollstedt

Meeks

Triaca

2019

Therapeutic Advances in Urology

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Background:Our aim was to investigate longer-term surgical and quality of life (QOL) outcomes in a cohort of women undergoing robotic-assisted laparoscopic sacrocolpopexy (RALS) for pelvic organ prolapse (POP).Methods:We performed a retrospective cohort study at a single institution of female patients undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient’s PFDI and PFIQ postoperative score by ⩾70%.Results:Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p = 0.011) and worse preoperative American Urological Association (AUA) Quality of Life score (OR 1.42, p = 0.046) were associated with clinical improvement. Within the PFIQ, 35.6% of patients saw clinical improvement with their bowel symptoms, compared with bladder (54.1%, p < 0.001) and prolapse (45.6%, p = 0.053) symptoms. Within the PFDI, 45.5% of patients reached clinical improvement with their bowel symptoms, compared with bladder (56.7%, p = 0.035) and prolapse (62.6%, p < 0.001) symptoms. Of the patients who had a rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score, and 51% saw clinical improvement in the bowel portion of the PDFI.Conclusions:Significantly fewer patients reached clinical improvement within the portions of the surveys that focus on bowel symptoms, compared with symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement with their bowel symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes

Vollstedt

Meeks

Triaca

2019

Therapeutic Advances in Urology

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“…One retrospective review of over 450 minimally-invasive sacrocolpopexies reported a prolapse recurrence rate of ~11% with no difference between robotic versus laparoscopic routes of surgery (30). A second retrospective case series of 195 RSC identified a 7% prolapse recurrence rate, with a retreatment rate of less than 5% (29). Similarly, in systematic reviews, whether restricting to randomized trials or including nonrandomized comparative trials, the outcomes between LSC and RSC are high and do not differ significantly (23,24).…”

Section: Robotic Sacrocolpopexymentioning

confidence: 99%

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Schachar¹,

Matthews²

2020

Transl Androl Urol

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The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females.Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques.The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients.Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

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“…However, adverse outcomes such as high rate of the Gram staining and post-culture failure to isolate the agent, or high false-negative rate in bacteriological and histological tests may be encountered (11,12). The systemic symptoms, such as fever, fatigue are rare, but the pain is often observed in this disease, and it has also sneaky and silent clinical course.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, to make a definite etiologic diagnosis; CT-guided percutaneous needle biopsy, open biopsy may be carried out, and in the cases, where the fistula from the epidural area to the skin tissue, associated with abscess formation is also observed, a definitive diagnosis may be made by identifying the causative microorganisms in culture antibiograms made from wound site swabs (10,11).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Neutrophil-to-lymphocyte ratio as a marker of inflammatory response in Spondylodiscitis

Karaarslan¹,

Yılmaz²,

Akgün³

et al. 2018

J Turgut Ozal Med Cent

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Aim: Spondylodiscitis, if not diagnosed on time, can cause morbidity or mortality at high rates. This study was carried out with the aim of testing the hypothesis that "neutrophil-to-lymphocyte ratio can be used" especially in cases where it is difficult to diagnose spondylodiscitis. Material and Methods: This study involved 24 patients admitted to the State Hospital of Ministry of Health and Namik Kemal University for spondylodiscitis between January2014 and June2017. After excluding the cases that did not meet the inclusion criteria (n=6), the remaining cases (n=24) were referred to as the study group. A control group was created from healthy volunteers (n=24) who applied for routine physical checkups at the clinic between the same dates and who were similar in terms of age, sex, and body mass index to the study group. Hemogram parameters of the cases in both groups; white blood cell, C-reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio were statistically compared. Results: Patients in the spondylodiscitis group, compared to healthy volunteers had statistically significant neutrophil-to-lymphocyte ratio value. Conclusion: Especially in cases where the diagnosis of spondylodiscitis is not assured, the neutrophil-to-lymphocyte ratio parameter, which is less costly than other diagnostic methods and the analysis results of which can be obtained in a shorter time, may be used to support clinical diagnosis.

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Perioperative Outcomes, Complications, and Efficacy of Robotic-Assisted Prolapse Repair: A Single Institution Study of 196 Patients

Abstract: In this large series of robotic prolapse repair, complications are infrequent. Short-term apical outcomes are excellent. Few women required additional compartment repairs within 1 year with 6% rate of mesh exposure.

Cited by 15 publications

References 18 publications

Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes

Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Evaluation of Neutrophil-to-lymphocyte ratio as a marker of inflammatory response in Spondylodiscitis

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