Mid term outcome of robotic mesh sacrocolpopexy

Michael Belsante, Sunshine Murray, Benjamin Dillon, Philippe Zimmern
Canadian Journal of Urology 2013, 20 (1): 6656-61

INTRODUCTION: Use of robotic mesh sacrocolpopexy (RMS) has increased for management of pelvic organ prolapse (POP). We present our experience with mid term follow up.

MATERIALS AND METHODS: A retrospective chart review of consecutive patients who had RMS was performed. Patients underwent history and physical exam including POP-Q classification. In cases of bladder involvement a standing voiding cystourethrogram and urodynamics with vaginal pack reduction of the prolapse were done. Indication for RMS was patient preference, BMI < 30, no prior major abdominal surgery, and age < 80. We utilized Marlex mesh and absorbable polyglactin sutures to anchor the mesh to the vaginal wall and apex. Follow up was at 6 weeks, 6 and 12 months and yearly thereafter. The Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) and a quality of life (QoL) questionnaire (range 0 excellent to 10 terrible) were obtained pre and postoperatively.

RESULTS: Thirty-five patients underwent RMS from January 2008 to July 2011 with at least 6 months follow up. Thirty-four patients (97%) had previous hysterectomy. Twenty-eight (80%) patients had previous surgery for pelvic organ prolapse (POP) and/or stress incontinence. Mean age and median follow up were 65 years (37-79) and 28 months (7-50) respectively. Mean preoperative C-point was -1.1 (+1 to -4) compared to -9.7 (-12 to -10) postoperatively (p < .0.001). Five intraoperative vaginotomies were repaired primarily. No patients required conversion to open. No patient had recurrent vault prolapse. Three patients had secondary POP procedures. One patient developed a mesh erosion requiring surgical repair. Functional outcome improvement was noted with score reduction for QoL of 4.1 to 1.3 (p < 0.001), UDI-6 of 27.3 to 16.1 (p = 0.002), and IIQ-7 of 18.3 to 3.9 (p = 0.031).

CONCLUSIONS: RMS performed reliably to correct symptomatic POP. The use of absorbable sutures to secure the mesh to the vaginal walls resulted in satisfactory anatomic outcomes and did not increase the risk of mesh erosion.

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