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Perioperative adverse events after minimally invasive abdominal sacrocolpopexy.
Am J Obstet Gynecol. 2014 Nov; 211(5):547.e1-8.AJ

Abstract

OBJECTIVE

Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events.

STUDY DESIGN

This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data.

RESULTS

Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not.

CONCLUSION

Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.

Authors+Show Affiliations

Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address: cecile.a.unger@gmail.com.Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25088866

Citation

Unger, Cecile A., et al. "Perioperative Adverse Events After Minimally Invasive Abdominal Sacrocolpopexy." American Journal of Obstetrics and Gynecology, vol. 211, no. 5, 2014, pp. 547.e1-8.
Unger CA, Paraiso MF, Jelovsek JE, et al. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547.e1-8.
Unger, C. A., Paraiso, M. F., Jelovsek, J. E., Barber, M. D., & Ridgeway, B. (2014). Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. American Journal of Obstetrics and Gynecology, 211(5), e1-8. https://doi.org/10.1016/j.ajog.2014.07.054
Unger CA, et al. Perioperative Adverse Events After Minimally Invasive Abdominal Sacrocolpopexy. Am J Obstet Gynecol. 2014;211(5):547.e1-8. PubMed PMID: 25088866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative adverse events after minimally invasive abdominal sacrocolpopexy. AU - Unger,Cecile A, AU - Paraiso,Marie Fidela R, AU - Jelovsek,John E, AU - Barber,Matthew D, AU - Ridgeway,Beri, Y1 - 2014/08/01/ PY - 2013/12/20/received PY - 2014/04/26/revised PY - 2014/07/30/accepted PY - 2014/8/5/entrez PY - 2014/8/5/pubmed PY - 2015/3/7/medline KW - minimally invasive sacrocolpopexy KW - perioperative adverse events KW - rectopexy SP - 547.e1 EP - 8 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 211 IS - 5 N2 - OBJECTIVE: Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events. STUDY DESIGN: This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data. RESULTS: Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not. CONCLUSION: Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/25088866/Perioperative_adverse_events_after_minimally_invasive_abdominal_sacrocolpopexy_ DB - PRIME DP - Unbound Medicine ER -