Barboglio Paholo G, Toler Andrew J W, Triaca Veronica
From the *Department of Surgery, Division of Urology, Dartmouth-Hitchcock Medical Center, Lebanon; †The Dartmouth Institute, Hanover; and ‡Concord Urology, Concord, NH.
Female Pelvic Med Reconstr Surg. 2014 Jan-Feb;20(1):38-43. doi: 10.1097/SPV.0000000000000047.
Transabdominal sacrocolpopexy is a definitive treatment option for vaginal vault prolapse with durable success rates. The aim of our study was to review subjective and objective outcomes including complications after robotic assisted laparoscopic sacrocolpopexy for the repair of symptomatic pelvic organ prolapse.
Single-site retrospective cohort study of women undergoing robotic assisted laparoscopic sacrocolpopexy with and without concomitant robotic assisted supracervical hysterectomy was performed. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 questionnaires were used preoperatively and postoperatively to evaluate patient subjective data, respectively. We established a strict improvement of greater than 70% on questionnaire's total score to determine clinical improvement.
Complications were assessed at 6 months and 127 women were included in our review. Mesh extrusion occurred in 3 (2.4%) patients. Other complications reported were bowel injury (2.4%), readmission rate (2.4%), wound infection (1.6%), and postoperative hernia at port site (1.6%). Objective and subjective outcomes were assessed at 1 year in 92 women. Although there was no recurrent apical prolapse at 1 year, anterior prolapse was present in 7 patients. Clinical improvement was present in 72% by Pelvic Floor Impact Questionnaire-7 and in 68% by Pelvic Floor Distress Inventory-20. Predictors of poor clinical outcomes were lysis of adhesions (OR, 5.83; 95% confidence interval [CI], 1.2-27.4; P = 0.026), urethrolysis (OR, 11.91; 95% CI, 1.2-117.9; P = 0.034), current smoking (OR, 7.9; 95% CI, 1.1-58.7; P = 0.042), and older age (OR, 1.1; 95% CI, 1.0-1.18; P = 0.044).
Robotic assisted laparoscopic sacrocolpopexy represents a safe and effective surgical therapy to manage symptomatic apical pelvic organ prolapse. Serious complication rates are low but not rare when assessing short-term outcomes.
经腹骶骨阴道固定术是治疗阴道穹窿脱垂的一种确定性治疗选择，成功率持久。我们研究的目的是回顾机器人辅助腹腔镜骶骨阴道固定术治疗有症状盆腔器官脱垂后的主观和客观结果，包括并发症。
对接受机器人辅助腹腔镜骶骨阴道固定术（伴或不伴机器人辅助子宫颈上子宫切除术）的女性进行单中心回顾性队列研究。术前和术后分别使用盆底功能障碍量表-20和盆底影响问卷-7来评估患者的主观数据。我们将问卷总分提高70%以上定义为严格改善，以此来确定临床改善情况。
在6个月时评估并发症情况，127名女性纳入我们的回顾研究。3名（2.4%）患者发生网片外露。报告的其他并发症包括肠损伤（2.4%）、再入院率（2.4%）、伤口感染（1.6%）和端口部位术后疝（1.6%）。92名女性在1年时评估客观和主观结果。虽然1年时没有复发性顶端脱垂，但7名患者存在前壁脱垂。根据盆底影响问卷-7，72%的患者有临床改善；根据盆底功能障碍量表-20，68%的患者有临床改善。临床结果不佳的预测因素包括粘连松解（比值比[OR]，5.83；95%置信区间[CI]，1.2 - 27.4；P = 0.026）、尿道松解（OR，11.91；95% CI，1.2 - 117.9；P = 0.034）、当前吸烟（OR，7.9；95% CI，1.1 - 58.7；P = 0.042）和年龄较大（OR，1.1；95% CI，1.0 - 1.18；P = 0.044）。
机器人辅助腹腔镜骶骨阴道固定术是治疗有症状的顶端盆腔器官脱垂的一种安全有效的手术治疗方法。评估短期结果时，严重并发症发生率较低但并非罕见。
