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van Oudheusden AMJ, Eissing J, Terink IM, Vink MDH, van Kuijk SMJ, Bongers MY, Coolen ALWM. Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial. Int Urogynecol J 2023; 34:93-104. [PMID: 36112182 PMCID: PMC9483545 DOI: 10.1007/s00192-022-05350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). METHODS Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC (n=37) or ASC (n=37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. RESULTS We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0-17; ASC: IQR 0-0) on the "genital prolapse" domain of the Urogenital Distress Inventory in both groups (p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% (n = 11) in the LSC group and 84.6% (n = 11) in the ASC group (p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). CONCLUSIONS At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. TRIAL REGISTRATION Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynecology and Obstetrics, Jeroen Bosch Hospital, P.O. Box 90153, 5200, ME, 's-Hertogenbosch, The Netherlands.
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Josephine Eissing
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130, MB, Sittard-Geleen, The Netherlands
| | - Ivon M Terink
- Utrecht General Practice Training Institute, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Maarten D H Vink
- Department of Gynecology and Obstetrics, Isala Medical Centre, P.O. Box 10400, 8000, GK, Zwolle, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Gynecology and Obstetrics, Máxima Medical Centre, P.O. Box 7777, 5500, MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology, Bergman Clinics, Marathon 1, 1213, PA, Hilversum, The Netherlands
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Souders C, Nik-Ahd F, Zhao H, Eilber K, Chugtai B, Anger J. Robotic sacrocolpopexy: adverse events reported to the FDA over the last decade. Int Urogynecol J 2019; 30:1919-1923. [PMID: 30617505 DOI: 10.1007/s00192-018-3845-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/30/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS As surgeons increase the volume of robotic abdominal sacrocolpopexies (rASCs) and become more experienced, a subsequent decrease in the number of adverse events is expected over time. Further, as the leading manufacturer of the operative robot (Intuitive Surgical) improves the technology, adverse events should also decrease. We hypothesized that there has been a decrease in adverse event reporting for rASCs and that serious adverse events are rare. METHODS We performed a search of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. All entries with the manufacturer "Intuitive Surgical" were exported from 2007 to 2017. All entries with "sacrocolpopexy" were then isolated and analyzed. RESULTS The number of adverse events reported for rASC peaked in 2013 and 2014, at 107 and 124 respectively. In 2015 and 2016, the number dropped to 11 and 7 respectively. There were 334 reported adverse events from 2007 to 2017. Five (1.50%) were categorized as death, 33 (9.88%) as injury, and 296 (88.62%) as malfunction. Analysis of the malfunction reports found that 15 out of 296 (5.07%) were converted to open surgery, 4 out of 296 (1.3%) were converted to laparoscopic surgery, 4 out of 296 (1.3%) cases were aborted, and 6 out of 296 (2.03%) malfunctions resulted in patient injury. CONCLUSIONS Although the MAUDE database has its limitations, it does indicate that the number of adverse events reported for rASC peaked in 2013 and 2014 and has decreased annually since then. This may be due to improved proficiency of the surgeon and surgical team, in addition to improvements in the robot. When malfunctions do occur, they infrequently cause serious injury or have an impact on surgical approach.
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Affiliation(s)
- Colby Souders
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | - Farnoosh Nik-Ahd
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Hanson Zhao
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | - Karyn Eilber
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA
| | | | - Jennifer Anger
- Cedars-Sinai Medical Center, 99 N. La Cienega Blvd., Suite M102, Beverly Hills, CA, 90211, USA.
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Abstract
The number of surgeries for pelvic organ prolapse in the United States is increasing. Abdominal sacrocolpopexy has become the gold standard for women desiring a restorative repair of their apical pelvic organ prolapse. Despite the associated morbidity of abdominal sacrocolpopexy, advances in minimally invasive approaches have safely increased the number of these surgeries performed, especially among urologists. Moreover, a number of studies have demonstrated superior objective outcomes after abdominal sacrocolpopexy when compared with vaginal approaches. Variations in the technique are described, but no consensus exists on a standard approach.
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Affiliation(s)
- Wai Lee
- Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA.
| | - Justina Tam
- Department of Urology, Stony Brook Medicine, 101 Nicolls Road, HSC Level 9-040, Stony Brook, NY 11794, USA
| | - Kathleen Kobashi
- Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA
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Lo TS, Ibrahim R, Karim NB, Nawawi EA, Uy-Patrimonio MC. Trans-vaginal mesh surgery for management of recurrent pelvic organ prolapse following abdominal sacrocolpopexy. Taiwan J Obstet Gynecol 2018; 57:311-314. [PMID: 29673679 DOI: 10.1016/j.tjog.2018.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To evaluate the outcome of transvaginal mesh surgery as a management of recurrent pelvic organ prolapse, in patients previously treated with sacrocolpopexy. CASE REPORT A series of three patients who developed recurrent pelvic organ prolapse more than 9 years after sacrocolpopexy. A 50-year-old and two 77-year-old patients who presented with recurrent pelvic organ prolapse at 9, 15 and 17 years, respectively after the primary abdominal sacrocolpopexy were managed by transvaginal mesh surgery. CONCLUSION Management of recurrent pelvic organ prolapse using transvaginal mesh would be an option for patients treated previously by sacrocolpopexy.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan, Republic of China; Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Rami Ibrahim
- Fellow of the Division of Urogynecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Albashir Hospital, Amman, Jordan
| | - Nazura Bt Karim
- Fellow of the Division of Urogynecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
| | - Enie Akhtar Nawawi
- Fellow of the Division of Urogynecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Hospital Tengku Ampuan Zainab, Kota Bahru, Kelantan, Malaysia
| | - Ma Clarissa Uy-Patrimonio
- Fellow of the Division of Urogynecology, Department of Obstetrics & Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines
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Lua LL, Vicente ED, Pathak P, Lybbert D, Dandolu V. Comparative analysis of overall cost and rate of healthcare utilization among apical prolapse procedures. Int Urogynecol J 2017; 28:1481-8. [PMID: 28364131 DOI: 10.1007/s00192-017-3324-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The annual cost of prolapse surgeries is expected to grow at twice the rate of population growth. Understanding the economic impact of apical prolapse procedures, including sacrospinous fixation (SSF), abdominal sacrocolpopexy (ASC), and laparoscopic sacrocolpopexy (LSC), is crucial. We aimed to compare overall cost of SSF versus ASC and LSC, as well as health resource utilization, up to 90-day follow-up. METHODS Truven Marketscan Commercial Claims and Encounter databases 2008-2012 were used to calculate index and 90-day follow-up costs for SSF, ASC, and LSC with/without hysterectomy. Rates of inpatient readmissions, outpatient visits, and emergency room (ER) visits were also calculated during the follow-up period. Statistical analyses were performed using SAS 9.3. RESULTS There were 17,549 SSF, 6126 ASC, and 10,708 LSC procedures. Mean index cost was lower for SSF (US$10,993) than ASC ($12,763, p < 0.0001) and LSC ($13,647, p < 0.0001). Concurrent hysterectomy impacted costs. Follow-up costs were likewise lower for SSF ($13,916) than ASC ($15,716, p < 0.0001) and LSC ($16,838, p < 0.0001). Lower rates of readmission were reported in SSF (4.22%) than ASC (5.40%, p = 0.0001) and LSC (4.64%, p = 0.0411). The rate of at least one ER visit was also lower for SSF (10.9%) than for ASC (12.0%, p = 0.0170) and comparable with LSC (10.6%, p = 0.0302). CONCLUSIONS Overall mean costs are significantly lower for SSF than ASC/LSC, as are those for health resource utilization. Besides lower morbidity rates being associated with vaginal procedures, our results demonstrate another reason to consider the increased use of SSF over sacrocolpopexies in apical prolapse surgery.
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Inan AH, Toz E, Beyan E, Gurbuz T, Ozcan A, Oner O. Does menopausal status impact urinary continence outcomes following abdominal sacrocolpopexy without anti-incontinence procedures in continent women? Pak J Med Sci 2016; 32:851-6. [PMID: 27648027 PMCID: PMC5017090 DOI: 10.12669/pjms.324.9928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: We investigated the impact of menopausal status on urinary continence following abdominal sacrocolpopexy (ASC) without an anti-incontinence procedure in continent women. Methods: We conducted a clinical follow-up study of 137 patients diagnosed with stage 3 or higher pelvic organ prolapse (POP) without urinary incontinence between January 2012 and December 2014. Patients were provided with detailed a priori information pertaining to the abdominal sacrocolpopexy procedure and were invited to attend follow-up visits at 1, 3, 12, and 24 months. Follow-up visits included a gynecological examination, cough test, and validated Urinary Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) questionnaires. Results: The mean follow-up time for the cohort was 16.5±3.45 months. The study group was divided according to menopausal status: premenopausal (Group-1) and postmenopausal women (Group-II). Anatomical recurrence was not detected during the follow-up period in either group, but de novo stress urinary incontinence was seen in 15 of 53 (28.3%) Group-I patients and in 6 of 84 (7.1%; p < 0.01) Group-II patients. Conclusions: The risk of de novo stress urinary incontinence in postmenopausal women after ASC is low. However, premenopausal patients have a higher incidence of de novo stress incontinence which affect quality of life.
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Affiliation(s)
- Abdurrahman Hamdi Inan
- Abdurrahman Hamdi Inan, Department of Gynecology and Obstetrics, Ardahan State Hospital, Ardahan, Turkey
| | - Emrah Toz
- Emrah Toz, Department of Gynecology and Obstetrics, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emrah Beyan
- Emrah Beyan, Department of Gynecology and Obstetrics, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tutku Gurbuz
- Tutku Gurbuz, Department of Gynecology and Obstetrics, Ardahan State Hospital, Ardahan, Turkey
| | - Aykut Ozcan
- Aykut Ozcan, Department of Gynecology and Obstetrics, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Oznur Oner
- Oznur Oner, Department of Gynecology and Obstetrics, Ardahan Military Hospital, Ardahan, Turkey
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Abraham N, Quirouet A, Goldman HB. Trans abdominal sacrocolpopexy with autologous rectus fascia graft. Int Urogynecol J 2016; 27:1273-5. [PMID: 26994768 DOI: 10.1007/s00192-016-2987-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Extrusion and infection are potential postoperative complications when using synthetic mesh for abdominal sacrocolpopexy. Long-term follow-up in the Colpopexy and Urinary Reduction Efforts (CARE) trial revealed an estimated 9.9 % risk of mesh extrusion. There are 26 reports of spondylodiscitis after sacrocolpopexy with synthetic mesh. These surgical risks may be decreased by using autologous fascia. To date, there have been no reports of extrusion or spondylodiscitis after using autologous fascia for sacrocolpopexy. METHODS This video demonstrates transabdominal sacrocolpopexy with an autologous rectus fascia graft. A 76-year-old woman with symptomatic stage 3 prolapse also had a history of diverticulitis and sigmoid abscess requiring sigmoid colectomy with end colostomy and incidental left ureteral transection with subsequent left nephrostomy tube placement. She presented for colostomy reversal, ureteral reimplantation, and prolapse repair. Given the need for concomitant colon and ureteral reconstruction, the risk of infection was potentially higher if synthetic mesh were used. The patient therefore underwent transabdominal sacrocolpopexy with autologous rectus fascia graft. RESULTS At 4 months' follow-up the patient reported resolution of her symptoms and on examination she had no pelvic organ prolapse. CONCLUSION Transabdominal sacrocolpopexy using autologous rectus fascia graft is a feasible option, especially in cases in which infection and synthetic mesh extrusion risks are potentially higher.
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Jeon MJ, Moon YJ, Jung HJ, Lim KJ, Yang HI, Kim SK, Bai SW. A long-term treatment outcome of abdominal sacrocolpopexy. Yonsei Med J 2009; 50:807-13. [PMID: 20046422 PMCID: PMC2796408 DOI: 10.3349/ymj.2009.50.6.807] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/29/2009] [Accepted: 02/10/2009] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse >or= stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.
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Affiliation(s)
- Myung Jae Jeon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo Jung Moon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Jung
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Jin Lim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo In Yang
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sei Kwang Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wook Bai
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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