Factors associated with intraoperative conversion during robotic sacrocolpopexy

Abstract

Objective To evaluate for potential predictors of intraoperative conversion from robotic sacrocolpopexy (RSC) to open abdominal sacrocolpopexy.Patients and Methods We identified 83 consecutive patients from 2002-2012 with symptomatic high-grade post-hysterectomy vaginal vault prolapse that underwent RSC. Multiple clinical variables including patient age, comorbidities (body-mass index [BMI], hypertension, diabetes mellitus, tobacco use), prior intra-abdominal surgery and year of surgery were evaluated for potential association with conversion.Results Overall, 14/83 cases (17%) required conversion to an open sacrocolpopexy. Patients requiring conversion were found to have a significantly higher BMI compared to those who did not (median 30.2kg/m2 versus 25.8kg/m2; p=0.003). Other medical and surgical factors evaluated were similar between the cohorts. When stratified by increasing BMI, conversion remained associated with an increased BMI. That is, conversion occurred in 3.8% (1/26) of patients with BMI ≤25 kg/m2, 14.7% (5/34) with BMI 25-29.9 kg/m2 and 34.7% (8/23) with BMI ≥30 kg/m2 (p=0.004). When evaluated as a continuous variable, BMI was also associated with a significantly increased risk of conversion to an open procedure (OR 1.18, p=0.004).Conclusions Higher BMI was the only clinical factor associated with a significantly increased risk of intra-operative conversion during robotic sacrocolpopexy. Recognition of this may aid in pre-operative counseling and surgical patient selection.

Long‐term quality of life outcomes and retreatment rates after robotic sacrocolpopexy

“…Additionally, given the tertiary referral nature of our practice, patients treated with RSC at our institution might follow up locally, and those that are asymptomatic are not followed longitudinally. Finally, our conversion rate is higher than expected in a large series, and this might be secondary to the initial surgical learning curve and case complexity …”

The Impact of Obesity on Intraoperative Complications and Prolapse Recurrence After Minimally Invasive Sacrocolpopexy

“…18 Specifically, a Cochrane review of robotic versus traditional laparoscopic gynecologic surgery did not demonstrate a significant difference in conversion rates between the 2 routes for benign hysterectomy or sacrocolpopexy. 21,22,24 In this study, 7.6% of women met the definition of prolapse recurrence (prolapse at or beyond the hymen). There was no apparent association between obesity and recurrent prolapse.…”

“…Multiple case series have demonstrated an increased risk of conversion to open in obese women undergoing minimally invasive gynecologic surgery via a robotic or traditional laparoscopic approach. [21][22][23] However, previous studies comparing robotic and laparoscopic route of minimally invasive sacrocolpopexy in obese women have not demonstrated significant differences in complication rates. 18 Specifically, a Cochrane review of robotic versus traditional laparoscopic gynecologic surgery did not demonstrate a significant difference in conversion rates between the 2 routes for benign hysterectomy or sacrocolpopexy.…”

Laparoscopic lateral suspension for pelvic organ prolapse in a case with difficulty in performing laparoscopic sacrocolpopexy

“…Although the accurate rate of cases with difficulty in mesh fixation in LSC has not been reported, Brian et al . reported failure‐to‐progress during dissection of the promontory in four cases (4.8%) of robotic sacrocolpopexy . We experienced 13 difficult cases (1.1%) of mesh fixation on the promontory among 1148 cases in our department (in four cases, we were not able to actually fix the mesh).…”