A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse

Richard K Lee; Alexandre Mottrie; Christopher K Payne; David Waltregny

doi:10.1016/j.eururo.2013.12.064

A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse

Eur Urol. 2014 Jun;65(6):1128-37. doi: 10.1016/j.eururo.2013.12.064. Epub 2014 Jan 8.

Authors

Richard K Lee¹, Alexandre Mottrie², Christopher K Payne³, David Waltregny⁴

Affiliations

¹ Department of Urology, Weill Medical College of Cornell University, New York, NY, USA. Electronic address: ril9010@med.cornell.edu.
² Department of Urology, O.L.V. Clinic, Aalst, Belgium; O.L.V. Vattikuti Robotic Surgery Institute, Melle, Belgium.
³ Department of Urology, Stanford University, Palo Alto, CA, USA.
⁴ Department of Urology, University Hospital of Liège, Liège, Belgium.

PMID: 24433811
DOI: 10.1016/j.eururo.2013.12.064

Abstract

Context: Abdominal sacrocolpopexy (ASC) represents the superior treatment for apical pelvic organ prolapse (POP) but is associated with increased length of stay, analgesic requirement, and cost compared with transvaginal procedures. Laparoscopic sacrocolpopexy (LSC) and robot-assisted sacrocolpopexy (RSC) may offer shorter postoperative recovery while maintaining equivalent rates of cure.

Objective: This review evaluates the literature on LSC and RSC for clinical outcomes and complications.

Evidence acquisition: A PubMed search of the available literature from 1966 to 2013 on LSC and RSC with a follow-up of at least 12 mo was performed. A total of 256 articles were screened, 69 articles selected, and outcomes from 26 presented. A review, not meta-analysis, was conducted due to the quality of the articles.

Evidence synthesis: LSC has become a mature technique with results from 11 patient series encompassing 1221 patients with a mean follow-up of 26 mo. Mean operative time was 124 min (range: 55-185) with a 3% (range: 0-11%) conversion rate. Objective cure was achieved in 91% of patients, with similar satisfaction rates (92%). Six patient series encompassing 363 patients treated with RSC with a mean follow-up of 28 mo have been reported. Mean operative time was 202 min (range: 161-288) with a 1% (range: 0-4%) conversion rate. Objective cure rate was 94%, with a 95% subjective success rate. Overall, early outcomes and complication rates for both LSC and RSC appeared comparable with open ASC.

Conclusions: LSC and RSC provide excellent short- to medium-term reconstructive outcomes for patients with POP. RSC is more expensive than LSC. Further studies are required to better understand the clinical performance of RSC versus LSC and confirm long-term efficacy.

Patient summary: Laparoscopic and robot-assisted sacrocolpopexy represent attractive minimally invasive alternatives to abdominal sacrocolpopexy. They may offer reduced patient morbidity but are associated with higher costs.

Keywords: Female; Genitalia; Laparoscopy; Minimally invasive; Pelvic organ prolapse; Robotics; Sacrocolpopexy; Surgical procedures.

Publication types

Review

MeSH terms

Conversion to Open Surgery
Female
Humans
Laparoscopy* / adverse effects
Laparoscopy* / economics
Operative Time
Patient Satisfaction
Pelvic Organ Prolapse / surgery*
Robotic Surgical Procedures* / adverse effects
Robotic Surgical Procedures* / economics
Sacrum / surgery
Treatment Outcome
Vagina / surgery