title: Factors associated with intraoperative conversion during robotic sacrocolpopexy.
abstract: OBJECTIVE
  To evaluate for potential predictors of intraoperative conversion from robotic sacrocolpopexy (RSC) to open abdominal sacrocolpopexy.
  
  
  METHODS
  We identified 83 consecutive patients from 2002-2012 with symptomatic high-grade post-hysterectomy vaginal vault prolapse that underwent RSC. Multiple clinical variables including patient age, comorbidities (body-mass index [BMI], hypertension, diabetes mellitus, tobacco use), prior intra-abdominal surgery and year of surgery were evaluated for potential association with conversion.
  
  
  RESULTS
  Overall, 14/83 cases (17%) required conversion to an open sacrocolpopexy. Patients requiring conversion were found to have a significantly higher BMI compared to those who did not (median 30.2 kg/m(2) versus 25.8 kg/m(2); p=0.003). Other medical and surgical factors evaluated were similar between the cohorts. When stratified by increasing BMI, conversion remained associated with an increased BMI. That is, conversion occurred in 3.8% (1/26) of patients with BMI ≤ 25 kg/m(2), 14.7% (5/34) with BMI 25-29.9 kg/m(2) and 34.7% (8/23) with BMI ≥ 30 kg/m(2) (p=0.004). When evaluated as a continuous variable, BMI was also associated with a significantly increased risk of conversion to an open procedure (OR 1.18, p=0.004).
  
  
  CONCLUSIONS
  Higher BMI was the only clinical factor associated with a significantly increased risk of intra-operative conversion during robotic sacrocolpopexy. Recognition of this may aid in pre-operative counseling and surgical patient selection.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Linder
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: George K
authors.initials: GK
authors.lastname: Chow
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lindsay L
authors.initials: LL
authors.lastname: Hertzig
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Clifton
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Elliott
mesh_terms: D000368:Aged; D015992:Body Mass Index; D061887:Conversion to Open Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D012447:Sacrum / Q000601:surgery; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*