John C. Kefer, MD, PhD, Jihad Kaouk MD, Firouz Daneshgari, MD

Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio

Introduction: Surgical repair of the pelvic organ prolapse (POP) has historically been performed through abdominal or vaginal approaches. The International Consultation on Incontinence has recommended abdominal sacrocolpopexy (ASC) as the gold standard operation for advanced POP. New advances in robotic-assisted surgery make it possible to use minimally-invasive techniques in performing ASC. Robotic ASC combines the efficacy of abdominal sacrocolpopexy with the advantages of minimally invasive surgery for management of women with advanced FPOP.

Objectives: To assess management of advanced POP with robotic-assisted abdominal sacrocolpopexy (RASC) and evaluate outcomes using the pelvic organ prolapse quantification (POPQ) scale.

Methods: Women with symptomatic stages III and IV FPOP were evaluated at our institution. After complete clinical assessment, including POPQ-based physical examination and urodynamic studies, the patients underwent RASC with or without an anti-incontinence surgery in the presence (sacrouteropexy) or absence of uterus (sacrocolpopexy). The follow up exam at 3 months included POP-Q based examination and patient perception of improved quality of life questionnaire (QOLQ).

Results: Twelve women were consented for RASC; nine women underwent successful RASC, one patient required conversion to laparoscopic ASC, one to open ASC, and one to transvaginal anterior colporrhaphy due to extensive bowel adhesions involving the bladder. Mean patient age was 64 (50-79). Mean preoperative POP-Q stage was 3.1 (3-4). Mean preoperative POP-Q values were Aa: +0.9, Ba: +2, C: -1.0, Ap: -1.0, and Bp: -1.0. Mean postoperative values were Aa: -2.7, Ba: -4.7, C: -8.28, Ap: -2.29, and Bp: -4.14. Mean postoperative POP-Q stage was 0. Mean intraoperative EBL was 81cc (50-150). Mean hospital stay was 2.4 days (1-7 d). Five patients underwent concurrent placement of a TOT sling and one patient underwent concurrent Burch culposuspension for occult SUI. The patient perception of QOLQ improved significantly.

Conclusions: Our results demonstrate that RASC is safe and efficacious, and its outcomes compare favorably to the reported results for open or laparoscopic abdominal sacrocolpopexy.

UroToday.com Coverage of SUFU 2007

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