Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

doi:10.5489/cuaj.1858

. 2014 Mar;8(3-4):100-6.

doi: 10.5489/cuaj.1858.

Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

Hanhan Li¹, Jesse Sammon¹, Florian Roghmann², Akshay Sood¹, Michael Ehlert¹, Maxine Sun², Mani Menon¹, Humphrey Atiemo¹, Quoc-Dien Trinh³

Affiliations

¹ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
² Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;
³ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; ; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;

PMID: 24839477
PMCID: PMC4001629
DOI: 10.5489/cuaj.1858

Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

Hanhan Li et al. Can Urol Assoc J. 2014 Mar.

. 2014 Mar;8(3-4):100-6.

doi: 10.5489/cuaj.1858.

Authors

Hanhan Li¹, Jesse Sammon¹, Florian Roghmann², Akshay Sood¹, Michael Ehlert¹, Maxine Sun², Mani Menon¹, Humphrey Atiemo¹, Quoc-Dien Trinh³

Affiliations

¹ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI;
² Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;
³ Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; ; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC;

PMID: 24839477
PMCID: PMC4001629
DOI: 10.5489/cuaj.1858

Abstract

Objectives: Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS.

Methods: RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges.

Results: Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications.

Conclusions: The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intra-operative complications.

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Figures

**Fig. 1.**
Utilization of robot-assisted (RAVVS) versus open vaginal vault suspension (OVVS).

See this image and copyright information in PMC

Comment in

Changes in pelvic organ prolapse surgery.
De E. De E. Can Urol Assoc J. 2014 Mar;8(3-4):107-8. doi: 10.5489/cuaj.2082. Can Urol Assoc J. 2014. PMID: 24839478 Free PMC article. No abstract available.

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References

1. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. doi: 10.1016/S0029-7844(97)00058-6. - DOI - PubMed
1. Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188:108–15. doi: 10.1067/mob.2003.101. - DOI - PubMed
1. Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: A short version Cochrane review. Neurourol Urodyn. 2008;27:3–12. doi: 10.1002/nau.20542. - DOI - PubMed
1. Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: A comprehensive review. Obstet Gynecol. 2004;104:805–23. doi: 10.1097/01.AOG.0000139514.90897.07. - DOI - PubMed
1. Brown JS, Waetjen LE, Subak LL, et al. Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol. 2002;186:712–6. doi: 10.1067/mob.2002.121897. - DOI - PubMed

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[1] Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. doi: 10.1016/S0029-7844(97)00058-6. - DOI - PubMed

[2] Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6. doi: 10.1016/S0029-7844(97)00058-6. - DOI - PubMed

[3] Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188:108–15. doi: 10.1067/mob.2003.101. - DOI - PubMed

[4] Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol. 2003;188:108–15. doi: 10.1067/mob.2003.101. - DOI - PubMed

[5] Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: A short version Cochrane review. Neurourol Urodyn. 2008;27:3–12. doi: 10.1002/nau.20542. - DOI - PubMed

[6] Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: A short version Cochrane review. Neurourol Urodyn. 2008;27:3–12. doi: 10.1002/nau.20542. - DOI - PubMed

[7] Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: A comprehensive review. Obstet Gynecol. 2004;104:805–23. doi: 10.1097/01.AOG.0000139514.90897.07. - DOI - PubMed

[8] Nygaard IE, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: A comprehensive review. Obstet Gynecol. 2004;104:805–23. doi: 10.1097/01.AOG.0000139514.90897.07. - DOI - PubMed

[9] Brown JS, Waetjen LE, Subak LL, et al. Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol. 2002;186:712–6. doi: 10.1067/mob.2002.121897. - DOI - PubMed

[10] Brown JS, Waetjen LE, Subak LL, et al. Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol. 2002;186:712–6. doi: 10.1067/mob.2002.121897. - DOI - PubMed

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Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

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Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

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