Robot-Assisted Sacrocolporectopexy for Multicompartment Prolapse of the Pelvic Floor: A Prospective Cohort Study Evaluating Functional and Sexual Outcome.
BACKGROUND
Pelvic floor disorders are a major public health issue. For female genital prolapse, sacrocolpopexy is the gold standard. Laparoscopic ventral mesh rectopexy is a relatively new and promising technique correcting rectal prolapse. There is no literature combining the 2 robotically assisted techniques.


OBJECTIVE
This study was designed to evaluate the safety, quality of life, and functional and sexual outcomes of robot-assisted sacrocolporectopexy for multicompartment prolapse of the pelvic floor.


METHODS
This was a prospective, observational cohort study.


METHODS
The study was conducted in a tertiary care setting.


METHODS
All sexually active patients undergoing robot-assisted sacrocolporectopexy at our institution between 2012 and 2014 were included.


METHODS
Robot-assisted sacrocolporectopexy was the study intervention.


METHODS
Preoperative and postoperative (12 months) questionnaires using the Urinary Distress Inventory, Pescatori Incontinence Scale, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and Pelvic Floor Impact Questionnaire were completed. In addition Wexner and Vaizey incontinence scores and the Wexner constipation score were recorded postoperatively.


RESULTS
Fifty-one patients underwent robot-assisted sacrocolporectopexy (median follow-up, 12.5 months). The simplified Pelvic Organ Prolapse Quantification improved significantly (p < 0.0005) for all 4 of the anatomic landmarks. Both median fecal (preoperative and postoperative Pescatori 4 vs 3, p = 0.002) and urinary incontinence scores (Urinary Distress Inventory, 27.8 vs 22.2; p < 0.0005) improved significantly at 12 months. Postoperatively median Wexner (3) and Vaizey incontinence (6) and Wexner Constipation (7) scores were noted. A positive effect on sexual function (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score 31.8 vs 35.9; p = 0.002) and quality of life for each compartment (p < 0.0005) was observed. One patient (2%) developed mesh erosion. No multicompartment recurrences were detected.


CONCLUSIONS
This was a observational study with a limited follow-up, no control group, and no preoperatively validated constipation score.


CONCLUSIONS
Robot-assisted sacrocolporectopexy is a safe and effective technique for multicompartment prolapse in terms of functional outcome, quality of life, and sexual function.
1 Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands 2 Faculty of Science and Technology, Institute of Technical Medicine, Twente University, Enschede, the Netherlands 3 Department of Gynecology, Meander Medical Center, Amersfoort, the Netherlands.
Jan J
JJ
van Iersel
Chris J
CJ
de Witte
Paul M
PM
Verheijen
Ivo A M J
IA
Broeders
Egbert
E
Lenters
Esther C J
EC
Consten
Steven E
SE
Schraffordt Koops
D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017773:Pelvic Floor / Q000503:physiopathology / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020127:Recovery of Function; D012005:Rectal Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012725:Sexual Behavior; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome