Single-Incision vs. Multiport Robotic Sacrocolpopexy: 126 Consecutive Cases at a Single Institution

Robot-assisted laparoscopic sacrocolpopexy (RSC) has gained popularity as a method for easier intracorporeal suturing than conventional laparoscopic sacrocolpopexy. However, few studies have compared multiport RSC (MP-RSC) and single-incision RSC (SI-RSC). We aimed to compare perioperative outcomes between these techniques for advanced pelvic organ prolapse (POP). We analyzed 126 patients who underwent RSC for POP quantification (all stage III to IV) between March 2019 and May 2021 at Seoul Asan Medical Center. We prospectively collected operation-related data, including total operation time (OT; from skin incision to closure) and perioperative outcomes. A total of 106 and 20 patients underwent MP-RSC and SI-RSC, respectively. The mean ages were 57.49 ± 10.89 and 56.20 ± 10.30 years in the MP-RSC and SI-RSC groups, respectively. The mean total OT was significantly shorter for MP-RSC than for SI-RSC (105.43 ± 24.03 vs. 121.10 ± 26.28 min). The OT difference was 15.67 min (95% confidence interval, 3.90–25.85, p = 0.009). No statistically significant differences were observed in terms of perioperative variables (estimated blood loss, hospital stay) and postoperative adverse events (POP recurrence, mesh erosion). SI-RSC had comparable intraoperative and postoperative outcomes to MP-RSC, with additional cosmetic benefits. MP-RSC had significantly shorter OT than SI-RSC.

New “Wrinkle Method” for Intracorporeal Anterior Vaginal Wall Plication during Sacrocolpopexy

In this study, we introduce a new wrinkle method for intracorporeal anterior vaginal wall plication during sacrocolpopexy for pelvic organ prolapse (POP) aiming to decrease POP recurrence and postoperative vaginal wall mesh erosion. The wrinkle method was performed using robotic sacrocolpopexy (RSC) on 57 symptomatic POP patients. Sixty-six patients underwent conventional RSC before the development of the wrinkle method. Feasibility and perioperative outcomes were compared. The wrinkle method is not time consuming. The total operative time was shorter in the wrinkle group than in the non-wrinkle group; however, this was attributed to lower adhesiolysis in the wrinkle group. No differences were recorded in the mean estimated blood loss and complication rates between the two groups. In conclusion, although we were unable to confirm that the wrinkle method decreased POP recurrence and vaginal wall mesh erosion after RSC because of the short follow-up period, our preliminary findings are positive in terms of safety. Further long-term well designed randomized controlled trials are required to elucidate the benefits of the wrinkle method.

Our Minimally Invasive Sacrocolpopexy Experiences in Pelvic Organ Prolapse Treatment

Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.

Small Bowel Obstruction Secondary to an Internal Hernia after a Robotic Sacrocolpopexy with Mesh

Small bowel obstruction has been noted to occur in anywhere from 1-10% of patients with a history of abdominal surgery, and in 4.7% of patients after robotic surgery, all of these studies have focused mainly on adhesions being the source of obstruction