Robot-assisted procedures for advanced apical pelvic prolapse: long term anatomical and functional outcomes
Eleonora Russo (IT), Paolo Mannella (IT), Andrea Giannini (IT), Tommaso Simoncini (IT)
[Russo] Division of Obstetrics and Gynecology University of Pisa, [Mannella] Division of Obstetrics and Gynecology University of Pisa, [Giannini] Division of Obstetrics and Gynecology University of Pisa, [Simoncini] Division of Obstetrics and Gynecology University of Pisa
Context:The adequate support for the vaginal apex is an essential component of a durable surgical repair for women with advanced prolapse. The robotic approach to pelvic floor surgerys gaining acceptance as treatment of the primary repair of utero-vaginal prolapse. Abdominal Sacral Hystero-cervicopexy (ASC) is the gold standard procedure, and Robotic ASC (R-ASC) seems to be an efficient and reliable surgical option to repair apical vaginal prolapse. Lateral apical mesh suspension (LAS) to the abdominal wall is a recently developed surgical approach that fulfills the concepts of a newer easy technical strategy to suspend the apex. Robotic ALS (R-ALS) is a simple, safe and reproducible technique that results in effective correction of advanced apical and anterior defect. Objective:This study describes the medium and long-term anatomic and functional outcomes of R-ASC and R-ALS in a series of patients with advanced apical prolapse. Materials and Methods: From September 2013 to September 2016, we have performed 62 R-ALS and 44 R-ASC in patients with advanced apical prolapse. The main outcomes were anatomic and subjective cure at 6 and 12 months follow-up. Subjective cure rate of the most relevant symptoms was based on the assessment of the patients using standardised interview. Results: At 6 and 12 months follow-up the anatomic cure rate for the apex was > 95.5% in R-ASC and R-ALS series. All patients had significant improvement of the POP-related symptoms. No major complications were reported. Conclusion: sacrocolpopexy and lateral suspension are indicated in women with advanced apical defect. Our study reports excellent anatomic results at long-term follow-up with a low complication rate. Robotic assistance enhances the procedures, allowing safer dissection, and better and more precise mesh placement.