Michael Kee-Ming Shu1*, Kenneth Fan2, Kodjo Karikari1, Christopher Tyson3 and Abeer Eddib3
1Department of Obstetrics and Gynecology, The State University of New York, USA
2Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, USA
3Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Western New York Urology Associates, USA
Study Objective: Sacrocolpopexy has traditionally been the gold standard for apical prolapse repair. Sacrocolpoperineopexy has become increasingly prevalent for multi compartmental pelvic organ prolapse repair; however the impact of more radical pelvic dissections required for mesh along the entire vaginal length is unknown. This study aims to compare peri-operative outcomes associated with Robotic-Assisted Sacrocolpoperineopexy (R-ASCPP) compared to Robotic-Assisted Sacrocolpopexy (R-ASCP) with concomitant vaginal prolapse repair. Design: Retrospective cohort study. Setting: Academic-affiliated community hospital. Patients: Cases of R-ASCPP were compared to R-ASCP with concomitant anterior-posterior (A/P) compartmental repair controls between January 2013 and January 2019. A total of 126 women were identified. Interventions: N/A Measurements and main results: Cases of R-ASCPP (n=83) were compared to R-ASCP with A/P repair controls (43) in 2:1 ratio. Total operative time was 36 min shorter on average for cases (214 min vs. 250 min, p<0.05), with similar quantitative blood loss between groups (1.8 g/dL vs. 2.1 g/ dL, p=0.61). Both cases and controls had similar narcotic requirements in the post-anesthesia care unit (PACU) (1.72 MME vs. 2.13 MME, p=0.59) and the entire hospital admission (17.30 MME vs. 20.79 MME, p=0.81). Cases trended toward larger Post-Void Residual (PVR) bladder volumes (204 cc vs. 122 cc, p=0.12), with a larger percentage discharged with outpatient catheterization (32.5% vs. 14.3%, p<0.05). Patient demographics were similar among groups. Conclusion: R-ASCPP is a well-tolerated procedure, however, is associated with a statistically significant propensity for acute urinary retention. Surgeons should consider counseling R-ASCPP patients about the increased incidence for elevated PVRs requiring either intermittent or indwelling catheterization. Future investigation is warranted to better understand, prevent, and treat this increased incidence in a large population of R-ASCPP patients.
Kee-Ming Shu M, Fan K, Karikari K, Tyson C, Eddib A. Post-Operative Short-Term Outcomes of Robotic- Assisted Sacrocolpoperineopexy versus Sacrocolpopexy. Clin Surg. 2019; 4: 2661..