ABSTRACT
INTRODUCTION: Pelvic organ prolapse is a condition with high prevalence in elderly women. With increasing life expectancy and a desire for improved quality of life, a rise in the frequency of surgical treatments for these women is anticipated. The aim is to compare complication, success, and satisfaction rates among elderly patients (aged >70 years) in comparison to younger women undergoing robotic sacrocolpopexy, thereby assessing the safety and efficacy of this surgery in this group of patients. METHOD: A prospective observational comparative study of 123 robotic sacrocolpopexies conducted between December 2016 and June 2022. Patients were stratified by age (cutoff point: 70 years). Baseline characteristics, type, and grade of prolapse, intra and postoperative data, complications, functional and anatomical outcomes, and satisfaction levels were collected. RESULTS: Among the 123 patients, 62.6% were under 70 years old, while 37.4% were 70 years or older, exhibiting similar baseline characteristics, prolapse grade, and type. The percentages of intraoperative (6.5%) and postoperative complications (4.4-9%) were comparable in both age groups. Furthermore, success and satisfaction rates exceeded 90%, with no significant differences between women under and over 70 years during a two-year follow-up. CONCLUSION: Robotic sacrocolpopexy is at least as effective and safe in women aged 70 years or older as in younger individuals, with no higher rates of intra and postoperative complications and similar rates of anatomical and subjective success.
ABSTRACT
Introducción: El síndrome de atrapamiento del pudendo (SAP) se caracteriza por la presencia de dolor de características neuropáticas en el territorio del nervio pudendo (NP) asociado o no a alteraciones miccionales, defecatorias y sexuales. La descompresión quirúrgica del mismo constituye una alternativa eficaz y segura en los casos de fracaso de tratamiento conservador. El objetivo es describir el primer procedimiento de neurólisis robótica del pudendo realizada en nuestro país. Material y métodos: Se describe paso a paso la técnica de neurólisis laparoscópica asistida por robot del NP izquierdo realizada con monitorización neurofisiológica intraoperatoria en una paciente de 60 años de edad a quien se diagnosticó SAP izquierdo. Resultados: El procedimiento se realizó de forma satisfactoria sin complicaciones. Tras 24 h se procedió al alta hospitalaria. Se objetivó una reducción del dolor del 50% medida mediante Escala Visual Analógica a las 2 semanas del procedimiento, mantenida tras 10 semanas de la neurólisis. Conclusiones: La neurólisis robótica del NP constituye una vía de abordaje factible y segura, permitiendo una mejor visualización y precisión en la disección del NP. La monitorización neurofisiológica intraoperatoria es útil para la localización del NP y para la detección de cambios intraoperatorios tras la liberación del nervio
Introduction: Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country. Material and methods: We describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE. Results: The procedure was performed satisfactorily without complications. After 24h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analogue scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis. Conclusions: Robot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualisation and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve
Subject(s)
Humans , Female , Middle Aged , Robotic Surgical Procedures/methods , Pudendal Nerve/surgery , Urologic Surgical Procedures/methods , Intraoperative Neurophysiological Monitoring/methods , Laparoscopy/methods , Magnetic Resonance Imaging/methods , Decompression, Surgical/methodsABSTRACT
INTRODUCTION: Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country. MATERIAL AND METHODS: We describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE. RESULTS: The procedure was performed satisfactorily without complications. After 24h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analogue scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis. CONCLUSIONS: Robot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualisation and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve.
