INTRODUCTION AND AIM OF THE STUDY Pelvic organ prolapse (POP) is a common condition, affecting about 50% of women with children. It has been estimated that one in nine women will undergo a hysterectomy in their lifetime, and up to 10% of these women may need surgical repair of a major vaginal prolapse.  Since the da Vinci robotic system (Intuitive Surgical, Sunnyvale, California, USA) gained US Food and Drug Administration approval for use in gynaecological surgery in April 2005, the number and variety of gynaecological cases performed contin- ued to expand. Many women are now increasingly requesting uterine preservation, and hysterosacropexy (HSP) may be a viable option for those patients who need or desire a uterus- sparing surgery.  Until now, only few studies have been addressed to assess the outcomes of robot assisted histero-sacrocolpopexy and no randomized controlled trials or meta analysis have been conducted. The aim of our study is to evaluate the results and complication rate with standardized criteria in a series of female patients undergoing robot assisted laparosocpic histerosacropexy (RALHSP). MATERIALS AND METHODS A medical record review of all female patients consecutively undergone RALHSP for hysterocele > stage II from Febru- ary 2010 to November 2013 was performed. All patients were evaluated with history, and a complete urogynaecological examination with vaginal inspection and, in case of sign and/or symptom of stress urinary incontinence (SUI), with urodynamics. Operative outcomes included: operative time, intraoperative complications, estimated blood loss, length of hospital stay, conversion to laparotomy, time to catheter removal, post operative complications. Patients’ comorbidity was evaluated using the Charlson comorbidity index and ASA score; POP was assessed using the POP-Q system and all complications within 90 days of surgery were recorded and graded according to the Clavien Dindo system. After a minimum follow-up of 3 months a check-up was performed, including clinical examination and a 0-10 point scale (VAS) to achieve information about patient satisfaction. RESULTS Mean age was 58.26 11.08 years and Charlson score was 0 in 13 patients (86.6%) and ASA score was 2 in eleven patients (73.3%). Four patients (26.6%) underwent previous uro-gynaeco- logical surgery, respectively two anterior colpoplasty, one Perigee and Monarc positioning and one removal of ovarian cysts. All patients had uterine or vaginal prolapse stage > II and 2 patients showed urodynamic stress incontinence (USI). Median total operative time was 110 minutes (range: 75 - 205 minutes) and median estimated blood loss was 0 cc (range: 0– 50 cc). There was no intraoperative complication and no need of intra or post operative blood transfusion. The median catheterization time was 3 days (range: 1- 4 days) and mean hospitalization time was 4 days (range: 3-6 days); more than 50% of the patients were discharged within post operative day (POD) 4. According to Clavien-Dindo system, grade I early complications occurred in 26.6% of cases (4/15): two nausea episodes, one asymptomatic hypocalcemia and one asymptomatic hypoka- liemia (treated with electrolyte infusion); one patient (6.6%) had a grade II complication (diarrhoea treated with antibiotic therapy); no higher grades were observed. At a median follow up of 36 months (IQR: 32–43) median VAS score was 9 (IQR: 5.5–9.5). Overall, we observed 4 totally unsatisﬁed patients: three because of POP recurrence (hyster- ocele: VAS score 4, 0, 0, respectively) and one due to the persistence of dyspareunia, urgency and recurrent urinary tract infections (VAS score 1). POP Q evaluation showed a signiﬁcant improvement in patient undergoing RALSHP. At the last check- up, no patient showed evidence of cervical dysplasia or tumor. INTERPRETATION OF RESULTS The intra and post operative results of our study are signiﬁcantly in favour of our technique, with absence of conversions, low blood loss and low operative time and complication rate. The results of our study are better or at least overlapping, with regards to intraoperative outcomes, to the literature data, with the limitation of a small number of patients, however higher than literature, and slightly worse results with regard to functional outcome, although with a longer follow up. CONCLUSIONS RALHSP seems to be a safe and effective procedure, offering a low complication rate, low estimated blood loss, rapid recovery, preserving fertility in young patients. Prospective randomised clinical trials with long-term follow-up are needed, in order to compare the outcomes of RALSHP with traditional procedures.
|Titolo:||OUTCOMES AND POST-OPERATIVE COMPLICATIONS OF ROBOT-ASSISTED LAPAROSCOPIC HYSTEROSACROPEXY: INITIAL EXPERIENCE|
|Data di pubblicazione:||2015|
|Appare nelle tipologie:||01.05 Abstract in rivista|