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Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study.
BJOG. 2019 Jul; 126(8):1065-1073.BJOG

Abstract

OBJECTIVE

Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.

DESIGN

Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.

SETTING

Two European tertiary referral hospitals.

POPULATION

Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).

METHODS

Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).

MAIN OUTCOME MEASURES

Primary outcome: anatomical and subjective cure.

SECONDARY OUTCOMES

surgical safety and intraoperative variables.

RESULTS

A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).

CONCLUSIONS

This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.

TWEETABLE ABSTRACT

European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

van Zanten F
Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands. Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands.
Schraffordt Koops SE
Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands.
O'Sullivan OE
Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland.
Lenters E
Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands.
Broeders I
Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands. Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands.
O'Reilly BA
Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland. Department of Obstetrics and Gynaecology, University College Dublin, Dublin, Ireland. ASSERT Centre, University College Cork, Cork, Ireland.

MeSH

AgedCervix UteriColposcopyFemaleHumansHysterectomyMiddle AgedPelvic FloorPelvic Organ ProlapsePostoperative ComplicationsProspective StudiesRobotic Surgical ProceduresSacrumTertiary Care CentersTreatment Outcome

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

30924606

Clinical Trial Links

Clinical trial which this article describes

Citation

van Zanten, F, et al. "Robot-assisted Surgery for the Management of Apical Prolapse: a Bi-centre Prospective Cohort Study." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 126, no. 8, 2019, pp. 1065-1073.
van Zanten F, Schraffordt Koops SE, O'Sullivan OE, et al. Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study. BJOG. 2019;126(8):1065-1073.
van Zanten, F., Schraffordt Koops, S. E., O'Sullivan, O. E., Lenters, E., Broeders, I., & O'Reilly, B. A. (2019). Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study. BJOG : an International Journal of Obstetrics and Gynaecology, 126(8), 1065-1073. https://doi.org/10.1111/1471-0528.15696
van Zanten F, et al. Robot-assisted Surgery for the Management of Apical Prolapse: a Bi-centre Prospective Cohort Study. BJOG. 2019;126(8):1065-1073. PubMed PMID: 30924606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study. AU - van Zanten,F, AU - Schraffordt Koops,S E, AU - O'Sullivan,O E, AU - Lenters,E, AU - Broeders,Iamj, AU - O'Reilly,B A, Y1 - 2019/05/02/ PY - 2019/03/04/accepted PY - 2019/3/30/pubmed PY - 2019/6/18/medline PY - 2019/3/30/entrez KW - Pelvic organ prolapse KW - robot-assisted KW - sacral colpopexy KW - sacrocervicopexy KW - sacrocolpopexy SP - 1065 EP - 1073 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 126 IS - 8 N2 - OBJECTIVE: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data. DESIGN: Prospective observational cohort study (NCT01598467, clinicaltrials.gov) assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery. SETTING: Two European tertiary referral hospitals. POPULATION: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS). METHODS: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7). MAIN OUTCOME MEASURES: Primary outcome: anatomical and subjective cure. SECONDARY OUTCOMES: surgical safety and intraoperative variables. RESULTS: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%). CONCLUSIONS: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results. TWEETABLE ABSTRACT: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse. SN - 1471-0528 UR - https://www.unboundmedicine.com/medline/citation/30924606/Robot_assisted_surgery_for_the_management_of_apical_prolapse:_a_bi_centre_prospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -