Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study

Abstract

The apical prolapse has always been considered the most complex of the defects of the pelvic floor, for both the difficulty of the surgical corrective technique and for the high post-surgical recurrence rate. This is a fairly frequent pathological condition. It is estimated that in her life 1/10 women undergoes a hysterectomy and up to 10% of these requiring surgical correction of apical prolapse (1). The standard treatment for surgical management of apical prolapse is abdominal sacrocolpopexy (ASC) (2). The progress made in the field of laparoscopic surgery in the past decades and the numerous literature reports that confirmed the considerable advantages respect to abdominal open surgery, allowed the spread of laparoscopic sacrocolpopexy (LSC). The technique was introduced in 1994 by Nezhat, integrating the experience of open conventional surgery with the advantages of minimally invasive approach, in order to minimize morbidity and accelerating the recovery of patients (3). Today, the LSC can be considered the standard treatment for apical prolapse. Several studies over the years have compared the laparoscopic approach with the open abdominal surgery. LSC is associated with less intra-operative blood loss, reduction in post-operative pain and a shorter hospital stay (4). Currently, with reference to minimally invasive surgery the most advanced and sophisticated tool available is the DaVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, California, USA). The robotic surgical systems have been developed with the aim of facilitating the technically difficult procedures: the 3D-HD vision system, the use of a dedicated console and instruments with great flexibility and precision of the movements, also allow the execution of the most complex surgical maneuvers, acheiving excellent results. In the last years, several surgical operations were performed with robotic system, like robotic-assisted sacral colpopexy SUMMARY: Robotic versus laparoscopic sacrocolpopexy for apical prolapse: a case-control study.

Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

“…Studies comparing LS and RSC did not show differences between groups in success outcomes. Biler et al, in the study about abdominal sacropexy, LS and pectopexy, found no occurrences of de novo apical prolapse at 6 months follow‐up. In studies regarding pectopexy, we found one (2.3%) relapse of apical prolapse after pectopexy reported by Noe after 21.8 months of follow‐up and none in the initial study by Banerjee .…”

“…Native tissue repairs have gained popularity following FDA notifications . Since April 16, 2019, there have been no FDA‐approved surgical mesh products for transvaginal repair marketed for use in the United States.…”

“…Native tissue repairs have gained popularity following FDA notifications. 7,37,38,43 Since April 16, 2019, there have been no FDA-approved surgical mesh products for transvaginal repair marketed for use in the United States. POP procedures using synthetic mesh require additional attention because of possible complications.…”

“…In eight studies regarding sacropexy and pectopexy, no cases of mesh exposure or extrusion were found. 28,29,33,[40][41][42][43][44][45] In LS, the rates of mesh erosion were as follows: 1.25%, 36 1.7%, 46 2%, 30 2.7%, 38 and 3.2%. 39 The highest levels of mesh erosion were reported for LLS: 2%, 30 3.8%, 47 4.3%, 25 5.5%.…”

Renal endometriosis mimicking complicated cysts of kidney: report of two cases

“…These surgical procedures should to be performed by a surgical team experienced in general, gynaecological, adrenal and urological laparoscopic surgery also in urgency setting because we well know the possible intraoperative complications of this kind of surgery as bowel, bladder, ureteric and vascular injuries (29)(30)(31)(32)(33)(34)(35).…”