Efficacy and urodynamic analysis of robot assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse / 中华泌尿外科杂志

Objective:To explore the efficacy and safety of robot assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.Methods:The data of 16 patients who underwent robot assisted laparoscopic sacrocolpopexy in Beijing Hospital from September 2019 to May 2022 were collected. The average age was (73.5±9.3) years, the preoperative course was 4-240 months, the body mass index was (24.2±1.7) kg/m 2, the number of births was (1.7±0.8), and the quantitative index of pelvic organ prolapse (POP-Q) was grade Ⅲ -Ⅳ. The maximum urine flow rate before operation was (9.6±3.4) ml/s, the maximum detrusor pressure during urination was 26 (20, 32) cmH 2O, the first sense urine volume of the bladder was (119.1±39.4) ml, the first sense urine urgency volume of the bladder was (253.6±75.7) ml, the maximum bladder pressure capacity was (406.0±79.8) ml, and the residual urine volume was 10 (10, 28) ml. The preoperative PFDI-20 score was 100 (70, 122) and the PFIQ-7 score was 107 (90, 160). During the robot assisted laparoscopic sacrocolpopexy, the right area of the sacral promontory was exposed, the anterior and posterior walls of the uterus were separated, and the 2 cm small hole was separated from the right broad ligament of the uterus. The mesh was cut into a "Y" shape and passed through the small hole. The anterior and posterior leaves of the Y-shaped mesh were sutured to fix the cervix, and the other end was fixed to the anterior longitudinal ligament of the sacrum. The operation time and intraoperative bleeding were observed. The effect of surgery was evaluated by preoperative and postoperative urodynamic imaging, POP-Q stage, PFDI-20 score and PFIQ -7 score. Results:All the 16 operations were successfully completed. No injury of urethra, bladder, rectum, important blood vessels and nerves occurred during the operation. The average operation time was (255.6±56.0) min, and the average amount of bleeding was (28.8±18.2) ml. There was no inhibitory contraction wave in 7 patients (44%) before operation, suggesting that there was detrusor overactivity. After operation, the detrusor overactivity disappeared or significantly decreased in 7 patients. The postoperative follow-up period was 3-36 months. During the follow-up period, one patient had recurrence, and the rest had no prolapse and urination problems. The POP-Q stage was reduced to grade 0-Ⅰ after the operation. The subjective satisfaction rate of patients was 94%. The PFDI-20 score [13(8, 24)] and PFIQ -7 score [11(6, 15)] after operation were significantly reduced ( P<0.001), the initial urgent volume of bladder (272.5±88.5) ml was significantly increased compared with that before operation ( P=0.038), and the maximum volume of bladder (427.2±79.2) ml was significantly increased compared with that before operation ( P=0.006). Image urodynamics showed that the patient basically recovered the pelvic floor anatomy and achieved functional reduction. Conclusions:Robot assisted laparoscopic sacrocolpopexy has good subjective and objective effects in POP, low recurrence rate and less complications. It needs a larger sample size study for confirming the improvement of bladder function.

Therapeutic effect of robot-assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse / 中南大学学报(医学版)

OBJECTIVES@#To assess short-term functional outcomes achieved by robot-assisted sacrocolpopexy for pelvic organ prolapse.@*METHODS@#We retrospectively collected clinical and operative data for female patients who underwent either pure laparoscopic sacrocolpopexy (a control group, =20) or robot-assisted laparoscopic sacrocolpopexy (a study group, =20) between December 2017 and December 2018. The clinical indicators included age, gestational age, parity, the stage of pelvic organ prolapse. Perioperative data included operative time and total blood loss. Post-operative outcomes included hospital stay, the time of detaining urethral catheterization, and the restart of anal exhaust after surgery. At the same time, complications and quality of life were observed till 6 months after the surgery.@*RESULTS@#There were no definitely differences in the perioperative data between the 2 groups. It is worth mentioning that robot-assisted laparoscopic sacrocolpopexy was superior in strict operative time. With a follow-up of 6 months, the study group's anatomic repair rate was 100% (20/20), while the control group was 95% (19/20). Pelvic Floor Distress Inventory-short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short Form 7 (PFIQ-7) were used to evaluate patients' quality of life. There was no significant difference in the scores between the study group and the control group before and 6 months after surgery. Only the data of the PFDI-20 questionnaires at 1 month after operation were statistically significant, and in the control group was larger than that in the study group, showing that robotic surgery can recover faster than laparoscopy, and the quality of life can be improved quickly.@*CONCLUSIONS@#Robot-assisted laparoscopic sacrocolpopexy is a safe and reliable technique, faster than laparoscopy in recovery and has a short-term effect.

Long term follow-up study for abdominal sacrocolpopexy/sacrohysteropexy

Background: Pelvic organ prolapse is common in women and 7-9% undergo surgical repair. Abdominal sacrocolpopexy and sacrohysteropexy is the most durable operation for vault prolapse and Nulliparous prolapse respectively. The objectives of this study were to describe Anatomic and symptomatic outcomes up to 5 years after abdominal sacrocolpopexy or sacrohysteropexy.Methods: This study was conducted in ASCOMS hospital for a cohort of patients who underwent abdominal sacrocolpopexy (ASC) or sacrohysteropexy (ASH) in 2 years (2013-2015) and follow up done for a period of 5 years from 2015-2019. These patients were evaluated for subjective and objective outcomes following ASC and ASH. women completed questionnaires and were examined in gynaecology clinic. Prospective follow up study using standarised examination with pelvic organ prolapse quantification system (POP-Q) and questionnairesResults: In the present study, there was low incidence of intraoperative and postoperative complications as well as long term complications were significantly low. The anatomical cure rate and patient satisfaction rate was both 100%.Conclusions: Abdominal sacrocolpopexy for vault prolapse and sacrohysteropexy for Nulliparous prolapse is safe and effective method and is considered gold standard for treatment of Apical compartment prolapse.

Clinical analysis of modified laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse / 中国实用妇科与产科杂志

OBJECTIVE: To explore clinical effectiveness of modified laparoscopic sacrocolpopexy by using double-mesh in the treatment of pelvic organ prolapse.METHODS: A retrospective analysis was conducted in 61 patients with pelvic organ prolapse who received LSC from September 1,2012 to September 30,2017.Among 61 patients,32 cases received modified LSC(modified group)and 29 cases received traditional Y-mesh LSC(traditional group).The intraoperative and postoperative parameters were compared between the two groups and the improvement in subjective symptoms was evaluated by using the simple questionnaire(PFIQ-7)and subjective cure rate was assessed.RESULTS: The difference was of statistical significance in operation time[(127.34+7.88)min vs.(143.28+15.38)min]between the modified group and the traditional group(P0.05).The median follow-up time of 61 patients was 28 months.In the modified group and traditional group,the objective cure rates were 96.86% and 89.65%,respectively.After operation each indicator point was recovered anatomically according to POP-Q,and there was statistical difference compared with before operation.The score of postoperative PFIQ-7 was obviously reduced compared to the preoperative parameter.The subjective cure rates of the modified group and traditional group were 100% and 94.74%,respectively.There was no new complications occurring in the modified group.There were 3 cases of postoperative mesh exposure in the traditional group.The symptoms of urinary incontinence disappeared after TVT-O in both groups.Two new cases of urinary incontinence occured in both groups after surgery.CONCLUSION: Both of the two operations for pelvic organ prolapse are safe and effective.The modified LSC is an alternative surgical option for ptatients with pelvic organ prolapse because of its advantages,such as simpler operation,shorter operation time,and fewer longterm complications.

Therapeutic effects of transvaginal natural orifice transluminal endoscopic surgery sacrocolpopexy on pelvic organ prolapse / 中国实用妇科与产科杂志

OBJECTIVE: To study the efficacy of transvaginal natural orifice transluminal endoscopic surgery(vNOTES)sacrocolpopexy in the treatment of pelvic organ prolapse(POP).METHODS: From June 2017 to September 2018,33 POP patients who underwent vNOTES sacrocolpopexy in the Third Affiliated Hospital of Guangzhou Medical University were collected.The operative time,blood loss and postoperative complications were recorded to evaluate the safety of the operation.After regular follow-up,POP-Q was used to objectively evaluate the effect of surgery,and PFIQ-7 was used to evaluate the recovery effect.RESULTS: In this group,3 of 33 cases were converted to transumbilical laparoscopy,and in the remaining 30 cases the surgery was successfully completed.The operation time was(184.97±41.91)min,and mean estimated blood loss was(28.33±18.77)mL.No complications such as exposure or infection of mesh were found after operation.The POP-Q indicators were significantly improved in 1,3,6 months after surgery(P<0.05),and the quality of life was better after operation than before(P<0.05).CONCLUSION: vNOTES is a feasible and safe approach for sacrocolpopexy with positive short-term efficacy in the treatment of POP.

Laparoscopic Sacrocolpopexy Plus Colporrhaphy With an Small Intestine Submucosa Graft Versus Total Pelvic Floor Reconstruction for Advanced Prolapse: A Retrospective Cohort Study / 대한배뇨장애요실금학회지

PURPOSE: Transvaginal mesh (TVM) results in a greater anatomic cure but more complications. We aimed to compare laparoscopic sacrocolpopexy (LSC) plus colporrhaphy with the small intestine submucosa (SIS) graft versus TVM for advanced pelvic organ prolapse (POP).

Recurrencia en pacientes intervenidas mediante sacrocolpopexia laparoscópica por prolapso de cúpula vaginal poshisterectomía / Vaginal Vault Prolapse Recurrence in Patients Undergoing Laparoscopic Sacrocolpopexy

Introducción: el prolapso de cúpula vaginal es una complicación que afecta entre 0,2 y 2 por ciento de las pacientes con antecedente de histerectomía total. La meta principal del tratamiento quirúrgico consiste no solo en mejorar la sintomatología, sino además evitar la recurrencia. Objetivo: determinar la frecuencia de la regularidad en pacientes intervenidas mediante sacrocolpopexia laparoscópica por prolapso de cúpula vaginal poshisterectomía y su posible relación con algunas variables sociodemográficas y quirúrgicas. Métodos: se realizó un estudio observacional, descriptivo y transversal, en una serie consecutiva de 41 pacientes atendidas quirúrgicamente en el Centro Nacional de Cirugía de Mínimo Acceso de La Habana, Cuba desde el 1º de agosto de 2008 hasta el 30 de abril de 2016. Resultados: la recurrencia se presentó en cinco pacientes de la serie (12,2 por ciento) después de un tiempo medio de seguimiento de 7,3 años. En ellas fue mayor la frecuencia de comorbilidad dado por la presencia de antecedentes patológicos personales (9,8 por ciento frente a 2,4 por ciento), así como de histerectomía previa por vía convencional en relación con la laparoscópica (7,3 por ciento frente a 4,9 por ciento). Las diferencias encontradas no fueron significativas. La tasa de éxito (supervivencia libre de recurrencia) a los cinco años fue de 84,4 por ciento. Conclusiones: se presentó una baja frecuencia de recurrencia en las pacientes intervenidas sin poder establecer su posible asociación con algunas variables seleccionadas(AU)

Introduction: Vaginal vault prolapse is a complication that affects 0.2 to 2 percent of patients with a history of total hysterectomy. The main goal of surgical treatment is not only to improve symptoms, but also to avoid recurrence. Objective: To determine the frequency of regularity in patients undergoing laparoscopic Sacrocolpopexy due to prolapse of the vaginal vault and its possible relation with some sociodemographic and surgical variables. Methods: An observational, descriptive and cross-sectional study was conducted in a consecutive series of 41 patients surgically treated at the National Center for Minimally Access Surgery, Havana, Cuba from August 1, 2008 to April 30, 2016. Results: Recurrence occurred in five patients of the series (12.2 percent) after a mean follow-up time of 7.3 years. Their frequency of comorbidity was higher due to the presence of personal pathological history (9.8 percent vs. 2.4 percent) as well as previous hysterectomy by conventional route in relation to laparoscopy (7.3 percent vs. 4.9 percent). The differences found were not significant. The success rate (recurrence-free survival) at five years was 84.4 percent. Conclusions: A low frequency of recurrence in the patients who underwent surgery. It was not possible to establish their possible association with some selected variables(AU)

Comparison of sexual function between sacrocolpopexy and sacrocervicopexy

OBJECTIVE: To compare sexual function before and 12 months after between sacrocolpopexy and sacrocervicopexy. METHODS: This retrospective study examined a cohort of 55 sexually active women who underwent either supracervical hysterectomy with sacrocervicopexy (n=28) or total abdominal hysterectomy with sacrocolpopexy (n=27) for stage II to IV pelvic organ prolapse. Pelvic floor support was measured with Pelvic Organ Prolapse-Quantification examination. Pelvic floor function was measured with the Pelvic Floor Distress Inventory-Short Form 20 and sexual function was measured with Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-Short Form 12 (PISQ-12). RESULTS: Baseline pelvic floor symptoms, demographics and PISQ-12 questionnaire scores were similar between the two groups. Overall improvements in sexual function were seen based on PISQ-12 scores in both groups, but were not statistically significant. No differences were seen in PISQ-12 scores regardless of sparing the cervix or surgical route. Responses to the PISQ-12 question of avoiding sexual intercourse because of vaginal bulging showed significant improvement in both group. No recurrences of prolapse occurred. CONCLUSION: In women with pelvic organ prolapse, sexual function after either sacrocolpopexy or sacrocervicopexy was not different. Sexual dysfunction in terms of avoidance of sexual activity because of vaginal bulging was greatly improved in both groups with statistical significance.

Surgical Outcomes and Safety of Robotic Sacrocolpopexy in Women With Apical Pelvic Organ Prolapse / 대한배뇨장애요실금학회지

PURPOSE: This study aimed to investigate the surgical outcomes and safety of robotic sacrocolpopexy (RSC) in patients with uterine/vaginal vault prolapse. METHODS: Between January 2009 and June 2015, 16 women with apical prolapse underwent RSC. Pelvic organ prolapse quantification (POP-Q) examination was performed, and treatment success was defined as the presence of grade 0 or I apical prolapse upon POP-Q examination at the final follow-up. Pelvic floor distress inventory-short form 20 (PFDI-SF 20) was administered at every follow-up. A treatment satisfaction questionnaire was administered by telephone to evaluate patient satisfaction with the operation. RESULTS: Median age was 65 years (interquartile range [IQR], 56–68 years), and follow-up duration was 25.3 months (IQR, 5.4–34.0 months). Thirteen women (81.3%) had ≥grade III apical prolapse. Operation time was 251 minutes (IQR, 236–288 minutes), and blood loss was 75 mL (IQR, 50–150 mL). Median hospital stay was 4 days (IQR, 3–5 days). At the final follow-up, treatment success was reported in all patients, who presented grade 0 (n=8, 57.1%) and grade I (n=6, 42.9%) apical prolapse. Dramatic improvements in PFDI-SF 20 scores were noted after RSC (from 39 to 4; P=0.001). Most patients (12 of 13) were satisfied with RSC. An intraoperative complication (sacral venous plexus injury) was reported in 1 patient, and there was no conversion to open surgery. Mesh erosion was not reported. CONCLUSIONS: RSC is an efficient and safe surgical option for apical prolapse repair. Most patients were satisfied with RSC. Thus, RSC might be one of the best treatment options for apical prolapse in women.

Surgical Outcomes of a Combined Surgical Approach for Apical Prolapse Repair / Resultados cirúrgicos de uma abordagem cirúrgica combinada para a correção do prolapso apical

Abstract Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n =135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity =2.49) and overweight (mean BMI =27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intraoperative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.

Resumo Introdução Objetivamos avaliar a segurança, eficácia e desfechos cirúrgicos da via laparoscópica e vaginal combinadas para a correção do prolapso feitos por dois cirurgiões. Métodos Um estudo retrospectivo com análise de prontuário foi realizado em todos os pacientes (n =135) que foram submetidos a correção de prolapso apical de fevereiro de 2009 a dezembro de 2012 de maneira concomitante por um laparoscopista e um uroginecologista. Dados demográficos (idade, índice de massa corporal [IMC], raça, número de gestações e partos) e cirúrgicos (perda sanguínea estimada, tempo operatório, complicações intraoperatórias, taxas de readmissão e reoperação, e presença de infecção pós-operatória) foram analisados. Resultados Operfil da paciente operada era pertencente à pós-menopausa (58,91%), ser multípara (paridade média =2,49) e com sobrepeso (IMC médio =27,71). Aproximadamente 20% havia feito cirurgia prévia para prolapso. O procedimento cirúrgico mais realizado foi a histerectomia supracervical laparoscópica (HSL) com sacrocervicopexia (59,6%); o reparo vaginal mais encontrado foi o para defeito de compartimento posterior (78,68%). O tempo operatório mediano foi de 149 minutos (82-302), e a perda sanguínea estimada foi de 100 ml (10-530). Cinco complicações pós-operatórias, cinco readmissões e quatro reoperações foram encontradas. A realização de uma histerectomia em concomitância aos demais procedimentos não afetou os desfechos cirúrgicos ou anatômicos. Conclusão O reparo combinado do prolapso pela via laparoscópica e vaginal por dois cirurgiões em concomitância aparenta ser uma opção eficiente para o manejo operatório.

Perioperative and postoperative morbidity after sacrocolpopexy according to age in Korean women

OBJECTIVE: This study aimed to compare perioperative and postoperative morbidity of older and younger women undergoing sacrocolpopexy (SCP). METHODS: A retrospective study included 271 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse from November 2008 to June 2013 at our institution. By the review of medical records, perioperative and postoperative data including the length of the surgery, estimated blood loss, blood transfusion, the length of hospital stay, wound complications and febrile morbidity were collected. In addition, cardiovascular, pulmonary, gastrointestinal, genitourinary, or neurological adverse events were retrieved. The need for an indwelling urinary catheter or performance of clean intermittent self-catheterization, mesh erosion rate and the number of days required for each were included in the postoperative outcomes. For the outcome variable analyzed in this study, the patients was dichomotized into women aged 65 and older and those younger than 65. RESULTS: One hundred and thirty-five (49.8%) patients were younger than 65 and 136 (50.2%) were aged 65 and older. Older women had higher body mass index, vaginal parity and prior surgery for hysterectomy than younger women (P<0.05). And older women had higher baseline comorbidities, such as hypertension, diabetes, cardiac disease (P<0.05), and their American society of Anesthesiologist class was higher (P<0.001). In the perioperative and postoperative complication, older group showed no differences in most of the operation-related complication rates, but gastrointestinal complication rate. Also, mesh erosion rate was not found to be significantly different between the two groups at the last visit. CONCLUSION: Older women undergoing laparotomic SCP have similar perioperative and postoperative morbidities as younger women, suggesting surgeons can counsel older and younger women similarly in terms of operative risks.

Significant gastrointestinal morbidity after sacrocolpopexy: The incidence and risk factors

OBJECTIVE: This study aimed to quantify the risk of significant gastrointestinal (GI) morbidity after sacrocolpopexy (SCP), and to identify related risk factors. METHODS: A retrospective study was performed of 258 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse (POP) from November 2008 to August 2013. By the review of medical records, the frequency of significant GI morbidity that resulted in a prolonged initial hospitalization, readmission, or reoperation was assessed. Thereafter, risk factors for significant GI morbidity were assessed using univariate and multivariate analyses. RESULTS: Ten patients (3.9%) were identified as having significant GI morbidity; nine (3.5%) had a prolonged initial hospital stay or were readmitted for the medical treatment of postoperative ileus and 1 (0.4%) underwent reoperation for small bowel obstruction. The occurrence of significant GI morbidity was significantly associated with patient's age and prior laparotomy. By multivariable logistic regression analysis, age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.27; P=0.03) and prior laparotomy (OR, 6.82; 95% CI, 1.37-34.07; P=0.02) were found as independent risk factors for significant GI morbidity. CONCLUSION: One in 25 (3.9%) women after SCP experiences significant GI morbidity. Particularly, women with older age and prior laparotomy have a higher risk for significant GI morbidity. This data will aid preoperative counseling for Korean POP patients undergoing SCP.

Sacrocolpopexia laparoscópica para el tratamiento del prolapso apical: resultados y seguimiento a largo plazo / Laparoscopic sacrocolpopexy for apical prolapse

Objetivos: Evaluar los resultados subjetivos, anatómicos y funcionales a largo plazo de las pacientes sometidas a sacrocolpopexia laparoscópica para manejo de prolapso apical. Métodos: Estudio observacional con pacientes a quienes se les hizo sacrocolpopexia laparoscópica entre febrero de 2006 y diciembre de 2012, en tres centros. El nivel de soporte del piso pélvico se midió mediante la escala de cuantificación del prolapso de órganos pélvicos (POP-Q). Los resultados funcionales se evaluaron mediante un cuestionario de síntomas intestinales, urinarios, sexuales y de molestias físicas. También se estimó la satisfacción global de las pacientes con una escala de uno a diez. Resultados: Se realizó sacrocolpopexia laparoscópica a 68 pacientes, pero el seguimiento fue posible sólo en 24. Ninguna paciente tuvo prolapso apical postoperatorio. El punto C medio del POP-Q fue -6,8 cm. Se observó mejoría importante con respecto a los síntomas subjetivos de prolapso con reducciones significativas en las puntuaciones del cuestionario en el seguimiento postoperatorio. La satisfacción fue en promedio de 9,1. La incontinencia urinaria preoperatoria se resolvió en el 35 por ciento de las que la reportaron, sin necesidad de cirugía de continencia concomitante. No hubo complicaciones a corto plazo. A largo plazo hubo una hernia incisional en el sitio del trocar y una obstrucción intestinal por la malla. Conclusión: La sacrocolpopexia laparoscópica es un tratamiento quirúrgico seguro y eficaz para el prolapso apical post-histerectomía. Proporciona un excelente soporte apical y buen nivel de satisfacción, con una mejoría general de los síntomas de prolapso.

Objective: To evaluate the long-term subjective, anatomical and functional outcomes after laparoscopic sacrocolpopexy for apical prolapse. Methods: An observational study of women undergoing laparoscopic sacrocolpopexy between February 2006 and December 2012 was undertaken, at three centers. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Functional outcomes were assessed using a questionnaire of bowel, urinary, sexual and physical discomfort symptoms postoperatively. Also was assessed the overall satisfaction of surgery with a scale of one to ten. Results: During the period of the study, sacrocolpopexy was done in 68 patients, but follow-up was possible only in 24. At a mean follow up of 34 months, all 24 women had stage 0 vault support with point C of the POP-Q score averaging -6.8 cm. Subjective improvements in prolapse symptoms were observed with significant reductions in the questionnaire scores. The satisfaction measured with visual scale averaged 9.1. Fifteen women reported stress urinary incontinence before sacrocolpopexy, and it was resolved in 35 percent without concomitant continence surgery. New onset incontinence was reported in two women. There were no intraoperative and perioperative complications. The long term complications were an incisional hernia on the trocar port site and bowel obstruction caused by the mesh that needed intestinal resection. Conclusions: Laparoscopic sacrocolpopexy is a safe and effective surgical treatment for post-hysterectomy apical prolapse. It provides excellent apical support and good level of satisfaction, with overall improvement in prolapse symptoms.

Robot-assisted surgery in gynecology: indications and efficacy

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Some major advantages of robotic surgery are three-dimensional magnification and articulation beyond normal manipulation. It also detects and filters out any tremors in the surgeon's hand movements, so that they are suitable for microsurgery. Compared to laparotomy, robotic gynecological cancer surgery results in improved clinical outcomes and comparable lymph node yields. Radical trachelectomy is an alternative therapy in early cervical cancer in women who wish to retain fertility. Anatomic restriction to the vaginal approach such as lack of pelvic descent is overcome using the robotic technique. This also enables preservation of the uterine vessels and increased precision and visualization during surgery. Robotic and conventional laparoscopic hysterectomy are equivalent regarding surgical and clinical outcomes. Operating times are longer and costs are significantly higher for the robotic procedure. Robotic surgery has the potential to become an enabler for gynecologic minimally invasive surgery, especially suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased blood loss, complication rates, and length of stay. The ultimate role of robot-assisted laparoscopic myomectomy is to supplant open myomectomy as the standard of care for conservative surgical treatment of myomas. Robot-assisted treatment of deep infiltrating endometriosis is feasible and safe. Robotic sacrocolpopexy demonstrated similar short-term surgical outcome compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and a shorter length of stay. Except for its higher cost, robotic surgery in gynecology is feasible with a low complication rate and comparable surgical outcomes.

Resultados de una serie en corrección del prolapso de cúpula vaginal / Results from a vaginal cupula prolapsed correction

OBEJTIVOS: teniendo en cuenta como punto de partida las exigencias actuales en calidad de vida para pacientes en décadas avanzadas y las posibilidades de corrección quirúrgica para defectos del suelo pélvico, se realizó un estudio para evaluar resultados en pacientes tratadas en el Hospital Ramón González Coro entre el mes de febrero 2003 hasta octubre del 2007. También se propuso la caracterización de un grupo de pacientes con prolapso de cúpula vaginal tratadas por cirugía, así como la descripción de algunas variables clínicas, modalidades de tratamiento y eventos evolutivos. MÉTODOS: se hizo un estudio de tipo descriptivo retrospectivo para lo cual se tuvieron en cuenta las variables edad, paridad, tiempo de evolución, particularidades quirúrgicas y complicaciones. RESULTADOS: se presentaron resultados prometedores utilizando abordajes vaginales y abdomino- perineales, con solamente 9,6 por ciento de recidivas, aunque el seguimiento es de solo 4 años. Las complicaciones alcanzaron un 16,1 por ciento y el promedio de tiempo quirúrgico no rebasó los 150 min. CONCLUSIONES: se concluye que la reparación del prolapso de cúpula vaginal resulta una alternativa exitosa y de poco riesgo siempre que se respeten los criterios de individualizar la técnica requerida para cada paciente en particular

OBJECTIVES: Considering as a starting point the present demands in the quality of life for patients in advanced decades and the possibilities of surgical repair of pelvic floor, we made a study to assess results from patients seen in Ramón González Coro Gynecology and Obstetrics Hospital from February, 2003 to October,2007. Also we proposed the characterization of a group of patients diagnosed with vaginal cupula prolapse treated by surgery as well as the description of some clinical variables, treatment modalities and evolution events. METHODS: A retrospective and descriptive study was conducted taking into account the following variables: age, parity, course time, surgical distinctive features and complications. RESULTS There were promising results using vaginal and abdominal-perineal approaches, with only a 9,6 percent of relapses, although with a 4-years the follow-up. Complications were of 16,1 percent and the average surgical time was of only 150 minutes. CONCLUSIONS: We conclude that vaginal cupula prolapse is a successful option and with a low risk considering always the individual criteria of the required technique for each patient in particular

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

PURPOSE: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse > or = stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

Cirugía mínimamente invasiva: promontofijación laparoscópica con malla y anclaje de titanio para prolapso de cúpula vaginal / Minimally invasive surgery: laparoscopic promontofixation with mesh and titanium anchor for vaginal vault prolapse

OBJETIVO: Analizar y evaluar la factibilidad técnica, eficacia y seguridad de la promontofijación laparoscópica con malla y anclajes helicoidales de titanio para el tratamiento del prolapso de cúpula vaginal. MÉTODO: Entre noviembre de 2005 y julio de 2006, en el Servicio de Ginecología del Hospital Clínico de la Universidad Católica, se efectuaron 5 promontofijaciones laparoscópicas, utilizando técnica consistente en malla unida al promontorio del sacro con anclajes helicoidales de titanio. El rango de edad de las pacientes fue entre 46 y 65 años, con paridad vaginal entre 2 y 3. RESULTADOS: La técnica quirúrgica logró corregir el defecto en las 5 pacientes. No hubo complicaciones intraoperatorias, ni post operatorias, con rápida recuperación y reintegración a las actividades habituales. CONCLUSIONES: Nos enfrentamos a una novedosa técnica, segura y reproducible, con las ventajas de la laparoscopia, alta precoz y estéticamente óptima.

OBJECTIVE: To analyze and evaluate the technical feasibility, effectiveness and security of the laparoscopic sacrocolpopexy with mesh and helical titanium anchorages for the treatment of vaginal vault prolapse. METHOD: Between November 2005 and July 2006, five laparoscopic sacrocolpopexies, using this technique, took place in the Gynecology Service of the Clinical Hospital of Pontificia Universidad Católica de Chile, consisting of mesh joined to the sacro promontory with helical titanium anchorages. The age of the patients was between 46 and 65 years, with vaginal parity between 2 and 3. RESULTS: In all patients the surgical technique corrects the defect. There were no interoperating or postoperating complications, with a prompt recovery and reintegration to usual activities. CONCLUSIONS: We face a novel, safe and reproducible technique, with the advantages of the laparoscopy, early leave hospital and esthetically optimum.