Evaluating the morbidity and long-term efficacy of laparoscopic sacrocolpopexy with and without robotic assistance for p
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ORIGINAL ARTICLE
Evaluating the morbidity and long‑term efficacy of laparoscopic sacrocolpopexy with and without robotic assistance for pelvic organ prolapse M. Lallemant1,4 · C. Tresch1 · M. Puyraveau2 · S. Delplanque3 · M. Cosson3 · R. Ramanah1,4 Received: 5 September 2020 / Accepted: 12 November 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Objective The aim of our study was to compare the morbidity and long-term efficacy after laparoscopic sacrocolpopexy with and without robotic assistance. Methods We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage 2–4 vaginal prolapse performed between September 2015 and October 2018 in 2 Gynecologic Surgery Departments of France. Patients were separated into two groups: a laparoscopic sacrocolpopexy group (LS) and a robotic-assisted sacrocolpopexy group (RAS). The primary outcome measure was reoperation procedures for recurrent pelvic organ prolapse (POP). Results Two hundred and fourteen patients were included, 160 patients (75%) in the LS group and 54 patients (25%) in the RAS group. After a mean follow-up of 32.8 months, reoperation rate for recurrent POP and the recurrent POP rate were greater in the RAS group (9.2% versus 1.2%, p = 0.01 and 25.9% versus 7.5%, p = 0.0003, respectively). No significant difference was found in terms of immediate intraoperative (3.1% versus 1.8%, p = 1) and postoperative complications (1.9% versus 1.8%, p = 1). On comparing the 2 groups by bivariate analysis, RAS significantly increased the odds of reoperation for POP recurrence (OR = 7.8 CI 95% [1.5–41.6], p = 0.02) and the odds of global reoperation (OR = 3.8 CI 95% [1.4–10.4], p = 0.0095). Similarly, multivariate logistic analysis showed that RAS increased the risks of global reoperation (OR = 3.8 CI 95% [1.3–10.6], p = 0.01) after controlling high-grade prolapse. Conclusion Robotic sacrocolpopexy does not appear to give long-term clinical benefits. Recurrent POP and reoperation procedures seem to be more frequent in case of robotic-assisted surgery. Keywords Laparoscopic · Pelvic organ prolapse · Recurrence · Reoperation · Robotic · Sacrocolpopexy
Introduction
* M. Lallemant mlallemant@chu‑besancon.fr 1
Department of Gynecologic Surgery, Besancon University Medical Centre, 3 Alexander Fleming Boulevard, 25000 Besançon, France
2
Methodology department, uMETh, Inserm CIC 1431, Besancon University Medical Centre, Besançon, France
3
Department of Gynecologic Surgery, Jeanne de Flandre, University Medical Centre, Lille, France
4
Nanomedicine Imaging and Therapeutics Laboratory, INSERM EA 4662, University of Franche-Comte, Besançon, France
Sacrocolpopexy is a common surgery performed for pelvic organ prolapse (POP). It can be performed by laparoscopy or laparotomy. Currently, laparoscopy is considered the reference procedure as it presents several advantages such as minimal invasiveness, technical feasibility, operative safety, low morbidity, reduced hospital stay, earlier return to n
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