Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study

F van Zanten; S E Schraffordt Koops; O E O'Sullivan; E Lenters; Iamj Broeders; B A O'Reilly

doi:10.1111/1471-0528.15696

Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study

BJOG. 2019 Jul;126(8):1065-1073. doi: 10.1111/1471-0528.15696. Epub 2019 May 2.

Authors

F van Zanten^{1

2}, S E Schraffordt Koops¹, O E O'Sullivan³, E Lenters¹, Iamj Broeders^{2

4}, B A O'Reilly^{3

5

6}

Affiliations

¹ Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands.
² Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands.
³ Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland.
⁴ Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.
⁵ Department of Obstetrics and Gynaecology, University College Dublin, Dublin, Ireland.
⁶ ASSERT Centre, University College Cork, Cork, Ireland.

PMID: 30924606
DOI: 10.1111/1471-0528.15696

Abstract

Objective: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.

Design: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.

Setting: Two European tertiary referral hospitals.

Population: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).

Methods: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).

Main outcome measures: Primary outcome: anatomical and subjective cure.

Secondary outcomes: surgical safety and intraoperative variables.

Results: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).

Conclusions: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.

Tweetable abstract: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse.

Keywords: Pelvic organ prolapse; robot-assisted; sacral colpopexy; sacrocervicopexy; sacrocolpopexy.

Publication types

Multicenter Study
Observational Study

MeSH terms

Aged
Cervix Uteri / surgery
Colposcopy / methods*
Female
Humans
Hysterectomy / methods*
Middle Aged
Pelvic Floor / surgery*
Pelvic Organ Prolapse / surgery*
Postoperative Complications / etiology
Prospective Studies
Robotic Surgical Procedures / methods*
Sacrum / surgery
Tertiary Care Centers
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01598467