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 124min (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 202min (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.
Written by:
Lee RK, Mottrie A, Payne CK, Waltregny D. Are you the author?
Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; Department of Urology, O.L.V. Clinic, Aalst, Belgium; O.L.V. Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Urology, Stanford University, Palo Alto, CA, USA; Department of Urology, University Hospital of Liège, Liège, Belgium.
Reference: Eur Urol. 2014 Jan 8. pii: S0302-2838(13)01492-9.
doi: 10.1016/j.eururo.2013.12.064
PubMed Abstract
PMID: 24433811
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