Kenton Kimberly, Mueller Elizabeth R, Tarney Christopher, Bresee Catherine, Anger Jennifer T
From the *Departments of Obstetrics and Gynecology and Urology, Northwestern University, Feinberg School of Medicine, Chicago; †Departments of Urology and Obstetrics and Gynecology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL; ‡Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California-Los Angeles; and §Biostatistics and Bioinformatics Research Center and ∥Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
Female Pelvic Med Reconstr Surg. 2016 Sep-Oct;22(5):382-4. doi: 10.1097/SPV.0000000000000300.
The primary aim of this study was to report anatomic, symptom, and quality of life outcomes in women with symptomatic stage 2 or greater prolapse 1 year after randomization to robotic and laparoscopic sacrocolpopexy.
This is a planned ancillary analysis of the Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies trial, a randomized comparative effectiveness trial comparing costs and outcomes of robotic and laparoscopic sacrocolpopexy at 2 academic medical centers. At baseline and 1 year after surgery, women underwent standardized assessment including validated subjective pelvic floor outcomes and physical examination with prolapse assessment.
Sixty six (85%) of 78 randomized participants completed 1-year follow-up: 33 (87%) of 38 in the laparoscopic arm and 33 (83%) of 40 in the robotic arm (P = 0.59). Ninety-seven percent (32/33) in the laparoscopic group and 100% (33/33) in the robotic arm considered that their prolapse symptoms improved (P = 0.999). The cohort had significant improvement in all pelvic floor symptom and quality of life measures, which did not differ by treatment arm. Of women who were sexually active at 1 year, sexual function improved in both cohorts. No new serious adverse events, including mesh exposure or reoperation for prolapse, were identified between 6 months and 1 year after surgery. No women had a sacrocolpopexy mesh complication or reoperation for mesh exposure.
Minimally invasive sacrocolpopexy is associated with significant improvement in pelvic floor symptoms, anatomy, and sexual function. In addition, mesh exposure rates with lightweight polypropylene mesh seem to be lower than those reported with multifilament and heavier polypropylene mesh.
本研究的主要目的是报告随机接受机器人辅助和腹腔镜骶骨阴道固定术的2期及以上症状性脱垂女性在1年后的解剖学、症状及生活质量结果。
这是一项对“腹部阴道固定术：内镜手术策略比较”试验的计划辅助分析，该试验是一项随机对照有效性试验，比较了两家学术医疗中心机器人辅助和腹腔镜骶骨阴道固定术的成本和结果。在基线和术后1年，女性接受了标准化评估，包括经过验证的主观盆底结果和脱垂评估的体格检查。
78名随机参与者中有66名（85%）完成了1年随访：腹腔镜组38名中的33名（87%）和机器人辅助组40名中的33名（83%）（P = 0.59）。腹腔镜组97%（32/33）和机器人辅助组100%（33/33）认为其脱垂症状有所改善（P = 0.999）。所有盆底症状和生活质量指标在该队列中均有显著改善，且不同治疗组之间无差异。在术后1年仍有性生活的女性中，两组的性功能均有所改善。在术后6个月至1年期间，未发现新的严重不良事件，包括网片暴露或因脱垂再次手术。没有女性发生骶骨阴道固定术网片并发症或因网片暴露再次手术。
微创骶骨阴道固定术与盆底症状、解剖结构和性功能的显著改善相关。此外，轻质聚丙烯网片的网片暴露率似乎低于多丝和较重聚丙烯网片报道的暴露率。
