Ultrasonography and robotic-assisted laparoscopic sacrocervicopexy with pubocervical fascia reconstruction: comparison w
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ORIGINAL ARTICLE
Ultrasonography and robotic‑assisted laparoscopic sacrocervicopexy with pubocervical fascia reconstruction: comparison with standard technique Hugo H. Davila1,2,3,4 · Sarah Abdelhameed1 · Deni Malave‑Huertas2,3 · F. Felix Bigay2,3 · Kristy Crawford2,3 · Allen Friedenstab2 · Katharine Lum2 · Lindsey Bruce4 · Lindsey Goodman4 · Taryn Gallo4 Received: 1 November 2019 / Accepted: 30 January 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The objective of this study was to evaluate our technique of ultrasonography and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) versus standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) in the treatment of patients with symptomatic apical/anterior vaginal prolapse. A retrospective analysis was done using the data in two community hospitals. Thirty women presented with symptomatic vaginal apical prolapse and desired minimally invasive surgery (video): (a) standard robotic-assisted laparoscopic sacrocervicopexy (s-RALS) (n = 15) or (b) ultrasound and robotic-assisted sacrocervicopexy with pubocervical fascia reconstruction (u-RALS-PFR) (n = 15) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative staging. There was longer operating room time in the u-RALS-PFR group compared with the s-RALS group (average difference 35 min); however, sacral promontory dissection time was less in the u-RALS-PFR (average difference of 15 min). The anterior/posterior vaginal dissection and mesh tensioning time was longer in the u-RALS-PFR, as expected. There was only one surgical and anatomic failure (7%) in the s-RALS group after 6 months of surgery (POP Q = Aa + 1, Ba0, Ap-2, Bp-3, C-7). Our technique of ultrasonography and pubocervical fascia reconstruction during RALS appears to be feasible and safe. It aims to improve anterior and apical support, minimize the use of mesh and improve visualization during surgery. u-RALS-PFR approach will add some additional time during surgery but may provide better outcomes. Keywords Apical prolapse · Vaginal prolapse · Perineal ultrasound · Pelvic floor ultrasound · Endovaginal ultrasound · Perineal pelvic floor ultrasound · Mesh surgery
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11701-020-01051-0) contains supplementary material, which is available to authorized users. * Hugo H. Davila [email protected] 1
Urology and Pelvic Reconstructive Surgery, Florida Cancer Specialist and Research Institute, 3730 7th Terrace, Suite 101, Vero Beach, FL 32960, USA
2
Division of Urology and Gynecology, Department of Surgery, Cleveland Clinic Indian River Hospital, Vero Beach, Fl, USA
3
Florida State University College of Medicine, Fort Pierce Campus, Tallahassee, Fl, USA
4
Division of Urology and Gynecology, Department of Surgery, Sebastian River Medical Center, Sebastian,
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