Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Obstetrics and Gynecology, Shamir Assaf Harofe Medical Center, Tsrifin, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Minim Invasive Gynecol. 2022 Mar;29(3):409-415. doi: 10.1016/j.jmig.2021.11.002. Epub 2021 Nov 9.
To assess the outcome of robotic-assisted laparoscopic sacrocolpopexy (RALSCP) and to identify risk factors for surgical failure and long-term complications in patients at high risk for surgical failure.
Retrospective cohort study.
A university hospital.
Sixty-seven women with pelvic organ prolapse (POP) at high risk for surgical failure.
RALSCP from November 2012 to July 2020.
Information was collected from the electronic medical records. Preoperative and postoperative assessment included urogynecologic history, prolapse staging, cough stress test, and validated quality of life questionnaires. Anatomic success was defined as POP stage < 2 at the last follow-up. Mean follow-up was 24.6 ± 17.9 months. Sixteen women (23.9%) reported bulge symptoms at the latest follow-up; upon POP Quantification staging, surgical failure or recurrence was observed in 35 patients (52.2%). On multiple logistic regression analysis, a preoperative POP Quantification point Ba measurement ≥3 cm beyond the hymen was independently related to surgical failure. Late postoperative complications included 3 cases (4.5%) of postoperative ventral hernia and 5 cases (7.5%) of mesh erosion, all in patients operated using Ethibond sutures.
Anatomic success of RALSCP in POP patients at high risk for surgical failure is worse than previously reported. Advanced preoperative anterior vaginal wall prolapse is a risk factor for surgical failure. Delayed absorbable sutures for vaginal mesh fixation seem to be safer than multifilament, permanent sutures, in terms of the risk of mesh erosion.
评估机器人辅助腹腔镜骶骨阴道固定术（RALSCP）的结果，并确定高手术失败风险患者手术失败和长期并发症的风险因素。
回顾性队列研究。
一所大学医院。
67 名患有盆腔器官脱垂（POP）且高手术失败风险的女性。
2012 年 11 月至 2020 年 7 月行 RALSCP。
从电子病历中收集信息。术前和术后评估包括泌尿妇科病史、脱垂分期、咳嗽压力试验和经过验证的生活质量问卷。解剖学成功定义为最后一次随访时 POP 分期<2 期。平均随访时间为 24.6±17.9 个月。16 名女性（23.9%）在最近一次随访时报告有膨出症状；根据 POP Quantification 分期，35 名患者（52.2%）观察到手术失败或复发。在多变量逻辑回归分析中，术前 POP Quantification 点 Ba 测量值比处女膜后超出 3cm 与手术失败独立相关。术后晚期并发症包括 3 例（4.5%）术后腹侧疝和 5 例（7.5%）网片侵蚀，均发生在使用 Ethibond 缝线的患者中。
在高手术失败风险的 POP 患者中，RALSCP 的解剖学成功率不如先前报道的那样好。术前阴道前壁脱垂严重是手术失败的一个风险因素。对于阴道网片固定，延迟吸收缝线似乎比多股、永久性缝线更安全，可降低网片侵蚀的风险。
