Russo Eleonora, Giannini Andrea, Guevara Magdalena Montt, Mannella Paolo, Misasi Giulia, Falcone Maria, Simoncini Tommaso
Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
Int Urogynecol J. 2020 Aug;31(8):1647-1653. doi: 10.1007/s00192-019-04069-7. Epub 2019 Aug 6.
Robotic abdominal lateral suspension (RALS) is an innovative mini-invasive surgical technique that allows treating apical and anterior prolapse. The safety and efficacy of this strategy have not yet been tested.
We completed a prospective case series of 115 RALS to treat apical and anterior prolapse stage III or IV, with no or minimal (stage I) posterior defect. Clinical evaluation was performed with a simplified POP quantification system (POP-Q). Mean follow-up was 28 ± 4 months. Primary outcomes were objective and subjective cure; secondary outcomes were reoperation rate for recurrence, erosion rate and complications. Objective cure was defined as POP-Q ≤ 1. Subjective cure was defined as absence of vaginal bulge. Patient's satisfaction was measured using the Patient Global Impression of Improvement Scale (PGI-I).
There was a significant improvement in POP-Q score in all treated compartments with an objective cure rate of 88.7% for the anterior and 93.1% for the apical compartment (p < 0.0001). Subjective cure rate was 82%. The emergence of de novo high rectoceles was not significant in the cohort, as much as the development of de novo stress or urge urinary incontinence. Reoperation rate for POP was 11.3% (8 recurrent cystoceles without apical descent and 5 apical and anterior relapses). No postoperative complications of Clavien-Dindo grade ≥ 3a were seen. Mesh exposure rate was 0.9%; 58.2% patients compiled a PGI-I score at 18-24 months post-surgery, reporting high satisfaction rates.
RALS is highly effective at a mid-term follow-up for the treatment of advanced apical and anterior POP.
机器人辅助腹部侧方悬吊术（RALS）是一种创新的微创手术技术，可用于治疗顶端和前部脱垂。该手术策略的安全性和有效性尚未得到验证。
我们完成了一项前瞻性病例系列研究，纳入115例行RALS治疗顶端和前部III或IV期脱垂且无或仅有轻微（I期）后部缺损的患者。采用简化的盆腔器官脱垂定量系统（POP-Q）进行临床评估。平均随访时间为28±4个月。主要结局指标为客观治愈和主观治愈；次要结局指标为复发再手术率、侵蚀率和并发症。客观治愈定义为POP-Q≤1。主观治愈定义为无阴道膨出。使用患者整体改善印象量表（PGI-I）评估患者满意度。
所有治疗部位的POP-Q评分均有显著改善，前部客观治愈率为88.7%，顶端部位为93.1%（p<0.0001）。主观治愈率为82%。新发性高位直肠膨出的发生率在该队列中不显著，新发压力性或急迫性尿失禁的发生率也不显著。盆腔器官脱垂再手术率为11.3%（8例复发性膀胱膨出无顶端下移，5例顶端和前部复发）。未观察到Clavien-Dindo≥3a级术后并发症。补片暴露率为0.9%；58.2%的患者在术后18 - 24个月完成了PGI-I评分，报告显示满意度较高。
在中期随访中RALS对晚期顶端和前部盆腔器官脱垂的治疗非常有效。
