OUTCOMES AND POST-OPERATIVE COMPLICATIONS OF ROBOTASSISTED LAPAROSCOPIC HYSTEROSACROPEXY: INITIAL
EXPERIENCE
Pierpaolo Curti1, Carolina D’Elia1, Maria Angela Cerruto1, Francesca Maria Cavicchioli1, Francesco
Bianconi1, Niccolò De Luyk1, Matteo Balzarro1, Stefano Cavalleri1, Walter Artibani1
1
Urology Clinic, Department of Surgery, AOUI Verona, P.zza L.A. Scuro 10, 37134 Verona (Italy)
ABSTRACT
Background
Pelvic organ prolapse is a common condition, affecting about 50% of women with children. It has
been estimated that one in nine women will undergo a hysterectomy in their lifetime; moreover,
more than 10% of these women may need surgical repair of a major vaginal prolapse. Until now,
only few studies have been addressed to assess the outcomes of robot-assisted laparoscopic
hysterosacropexy (RALHSP) and no randomized controlled trials or meta analysis have been
conducted. The aim of our study was to evaluate the results and complication rate with standardized
criteria in a consecutive series of female patients undergoing RALHSP.
Materials and Methods
A medical record review of all female patients consecutively undergone RALHSP for hysterocele >
stage II from February 2010 to November 2013 was performed. Patients’ demographic and clinical
characteristics and intra- and post-operative (PO) variables were recorded.
Variable collected included age, BMI, prolapse stage, parity, comorbidities, lower urinary tract
symptoms (LUTS) associated, operative time, blood loss, postoperative (PO) complications, PO
catheter removal, hospital discharge. All complications within 90 days of surgery were recorded
and graded according to the Clavien-Dindo system. Patient satisfaction was evaluated using a VAS
scale from 0 to 10.
Results
Fifteen patients were included in the analysis. All patients had uterine prolapse stage > II +/anterior prolapse +/- urodynamic stress urinary incontinence (USI). Mean age was 58.26 + 11.08
years; median parity was 2 and mean BMI was 24.2 + 2.14.
All patients had uterine or vaginal prolapse stage > 2 and 2 patients showed a concomitant USI.
Median total operative time was 110 minutes (range: 75 - 205 minutes) and median estimated
blood loss was 0 cc (range: 0 – 50 cc).
All patients underwent RALHSP 2/15 underwent a concomitant TVT- O positioning for USI
without and with anterior colporraphy (because of an anterior vaginal wall defect).
There was no intraoperative complication and no need of intra or post-operative blood transfusion.
The median catheterization time was 3 days (range: 1- 4 days) and mean hospitalization time was 4
days (range: 3-6 days); more than 50% of the patients were discharged within PO day 4.
According to the Clavien-Dindo system, grade 1 early complications occurred in 26.6% of cases
(4/15) and one patient (6.6%) had a grade 2 complication; no higher grades were observed.
At a median follow up of 35 months a median satisfaction score of 9 (range 0-10) has been
reported, with only 3 out of 15 patients reporting a significant prolapse relapsing.
Discussion
Comparing our data with the literature, our results were better or at least overlapping. A limitation
of the study is the small number of patients, however higher than literature.
Conclusion
In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low
complication rate.
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