Conversion rate of laparoscopic or robotic to open sacrocolpopexy: are there associated factors and complications?
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ORIGINAL ARTICLE
Conversion rate of laparoscopic or robotic to open sacrocolpopexy: are there associated factors and complications? Perrine Capmas 1,2 & Eva Suarthana 1 & Maryse Larouche 1 Received: 26 June 2020 / Accepted: 14 October 2020 # The International Urogynecological Association 2020
Abstract Objectives To evaluate the conversion rate of laparoscopic or robotic to open sacrocolpopexy and to identify associated factors in a large population-based database. Methods We used Health Care Cost and Utilization Project-National Inpatient Sample (HCUP-NIS) databases 2005–2014. We extracted data on apical suspension and synthetic mesh with laparoscopy or robot in adult women using International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM) codes. We evaluated the rate of conversion and used logistic regression to study the association with risk factors. Results We identified 3295 women with laparoscopic or robotic sacrocolpopexies. There were 2777 robotic procedures with 37 conversion (1.33%) and 518 laparoscopic procedures with 37 conversions (7.14%), with an overall conversion rate of 2.2%. Median age was 62 years [interquartile range (IQR) = 55–69]. Concomitant hysterectomy was significantly more frequent in the robotic than laparascopic group (41.7% versus 13.9%, p < 0.01) and was not associated with conversion. Factors associated with lower conversion included a robotic approach (adjusted odd ratio (aOR) 0.32 [95% CI 0.19–0.54]) and private insurance (aOR 0.53 [95% CI 0.32–0.86]). Factors associated with higher conversion were obesity (aOR 3.27 [95% CI 1.72–6.19]) and lysis of adhesions (aOR 3.32 [95% CI 1.89–5.85]). Accidental organ puncture was significantly associated with conversion (14.9% versus 3.8%; p < 0.01). Conclusion In this American database, the rate of conversion of laparoscopic or robotic to open sacrocolpopexy was low. The majority (84%) of minimally invasive sacrocolpopexies used a robotic approach, which was associated with a lower risk of conversion. Obesity and lysis of adhesions were associated with a higher risk of conversion. Keywords Sacrocolpopexy . Conversion rate . Laparoscopic surgery . Robotic surgery
Introduction Sacrocolpopexy is considered the gold standard surgery for vaginal vault prolapse. Published data about the minimally invasive approach by laparoscopy or robotic surgery inconsistently reveal a longer operative time depending on studies, while demonstrating clear benefits with a decrease in blood loss, hospital stay and risk of postoperative ileus or
* Perrine Capmas [email protected] 1
Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
2
Inserm, Centre of Research in Epidemiology and Population Health (CESP), U1018, and Faculty of Medicine, University Paris Sud, 94276 Le Kremlin Bicêtre, France
obstruction [1–4]. Short- to medium-term subjective and objective results for vaginal vault prolapse appear similar between approaches to sacrocolpopexy, except that the risk of anterior prolapse recurrence se
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