title: Perioperative adverse events after minimally invasive abdominal sacrocolpopexy.
abstract: OBJECTIVE
  Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events.
  
  
  METHODS
  This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data.
  
  
  RESULTS
  Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not.
  
  
  CONCLUSIONS
  Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.
authors.affiliation: Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address: cecile.a.unger@gmail.com.
authors.forename: Cecile A
authors.initials: CA
authors.lastname: Unger
authors.affiliation: Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Marie Fidela R
authors.initials: MF
authors.lastname: Paraiso
authors.affiliation: Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: John E
authors.initials: JE
authors.lastname: Jelovsek
authors.affiliation: Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Barber
authors.affiliation: Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Beri
authors.initials: B
authors.lastname: Ridgeway
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000038:Abscess; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D056887:Pelvic Organ Prolapse / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D012447:Sacrum / Q000601:surgery*; D013526:Surgical Mesh; D001743:Urinary Bladder / Q000293:injuries; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: minimally invasive sacrocolpopexy; perioperative adverse events; rectopexy