Robinson Barbara L, Parnell Brent A, Sandbulte Jennifer T, Geller Elizabeth J, Connolly AnnaMarie, Matthews Catherine A
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA 30912, USA.
Female Pelvic Med Reconstr Surg. 2013 Jul-Aug;19(4):230-7. doi: 10.1097/SPV.0b013e318299a66c.
The primary objective was to compare perioperative complications after robotic surgery (RS) versus vaginal surgery (VS) for apical prolapse repair in elderly women. The secondary objectives were to (1) assess whether tools designed to predict surgical morbidity, the American Society of Anesthesiologists (ASA) class and the Charlson Comorbidity Index (CCI), are useful in the elderly urogynecologic population and (2) to classify complications during urogynecologic apical procedures using the Dindo classification system.
We reviewed medical records of women 65 years or older who underwent RS or VS between March 2006 and April 2011. Procedures included robotic sacrocolpopexy and sacrocervicopexy, vaginal uterosacral ligament suspension, sacrospinous ligament suspension, colpocleisis, and Uphold vaginal mesh placement. We assessed preoperative risks using ASA and CCI classification and complications using Dindo grade.
There were 136 eligible cases (RS, 70; and VS, 66) during the 5-year study period. Women who underwent RS were younger (70 vs 74 years; P < 0.001). Vaginal surgery had more severe comorbidities as measured by the CCI (P = 0.012) but similar ASA profiles (P = 0.10). Robotic surgery had longer operative times (P < 0.001) but a lower estimated blood loss (P < 0.001). There were fewer postoperative complications in RS (P = 0.005). However, complication severity based on Dindo grade was similar between RS and VS, with most surgeries having no complications.
In the elderly women, RS was associated with fewer postoperative complications than VS. Overall, all procedures were associated with few complications, and either route may be reasonable in the elderly population.
主要目的是比较老年女性机器人手术（RS）与阴道手术（VS）治疗顶端脱垂修复术后的围手术期并发症。次要目的是：（1）评估用于预测手术发病率的工具，即美国麻醉医师协会（ASA）分级和查尔森合并症指数（CCI），在老年泌尿妇科人群中是否有用；（2）使用丁多分类系统对泌尿妇科顶端手术期间的并发症进行分类。
我们回顾了2006年3月至2011年4月期间接受RS或VS的65岁及以上女性的病历。手术包括机器人骶棘韧带固定术和骶子宫颈固定术、阴道子宫骶韧带悬吊术、骶棘韧带悬吊术、阴道封闭术和Uphold阴道网片置入术。我们使用ASA和CCI分类评估术前风险，并使用丁多分级评估并发症。
在5年研究期间有136例符合条件的病例（RS组70例，VS组66例）。接受RS的女性更年轻（70岁对74岁；P<0.001）。根据CCI测量，阴道手术有更严重的合并症（P=0.012），但ASA概况相似（P=0.10）。机器人手术的手术时间更长（P<0.001），但估计失血量更低（P<0.001）。RS术后并发症更少（P=0.005）。然而，根据丁多分级，RS和VS之间的并发症严重程度相似，大多数手术无并发症。
在老年女性中，RS术后并发症比VS少。总体而言，所有手术的并发症都很少，两种手术途径在老年人群中可能都是合理的。
