title: Robotic and laparoendoscopic single-site utero-sacral ligament suspension for apical vaginal prolapse: evaluation of our technique and perioperative outcomes.
abstract: The objective of this study was to evaluate our technique and steps of robotic and laparoendoscopic single-site utero-sacral ligament suspension in the treatment of patients with symptomatic apical vaginal prolapse. A retrospective analysis was done using the data in 2 community hospital. Eighteen women presented with vaginal apex prolapse and desired minimally invasive surgery (video): (a) Laparoendoscopic single-site utero-sacral ligament suspension (LESS-UTSLS) (n = 13) or (b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) (n = 5) were eligible to participate. All participants underwent a standardized evaluation, including a structured urogynecologic history and physical examination with pelvic organ prolapse quantitative stage. Participants also completed validated questionnaire about pain scale. Multiples perioperative values were obtained to evaluate our minimally invasive approach. There were no differences in demographic, pre-operative anatomic, and functional data between groups. Concomitant anti-incontinence surgery with trans-obturator tape among the LESS-UTSLS vs RASS-UTSLS groups was performed in 2 (15 %) compared with 0 (0 %) and vaginal hysterectomy 2 (15 %) compared with supracervical hysterectomy 2 (40 %), respectively. The UTSLS operating time was similar in the RASS group compared with the LESS group (difference 9 min. There were only one POP (8 %) recurrence (stage 3) and one umbilical hernia (8 %) in the LESS-UTSLS group after 12 months of surgery. Two patients (15 %) developed stress urinary incontinence after LESS-UTSLS. We presented our technique and perioperative outcomes. RASS-UTSLS was similar operative times to LESS UTSL (+9 min), no differences in post-operative pain, anatomic support, or complications 6 months. We found that robotic surgical systems may accelerate the learning curve in the single-site surgery. Future investigations are warranted to discern the best applications for robotic single site technology in benign gynecologic surgery.
authors.affiliation: Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, Florida Cancer Specialist & Research Institute, 1627 US Highway 1, Suite 201, Vero Beach, Fl, 32958, USA. Hdavila@FLHealthcarespecialists.com.|Florida Cancer Specialist & Research Institute, 1627 US Highway 1, Suite 201, Sebastian, Fl, 32958, USA. Hdavila@FLHealthcarespecialists.com.|Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, Fl, USA. Hdavila@FLHealthcarespecialists.com.|Florida State University College of Medicine, Fort Pierce Campus, Tallahassee, Fl, USA. Hdavila@FLHealthcarespecialists.com.
authors.forename: Hugo H
authors.initials: HH
authors.lastname: Davila
authors.affiliation: Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, Fl, USA.
authors.forename: Taryn
authors.initials: T
authors.lastname: Gallo
authors.affiliation: Department of Surgery, Division of Urology and Gynecology, Sebastian River Medical Center, Sebastian, Fl, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Bruce
authors.affiliation: Department of Surgery, Division of Gynecology and Obstetrics, St. Joseph Health System, Michigan, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Landrey
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery
keywords: Apical prolapsed; Pelvic floor; Robotic surgery; Single-site surgery; Vaginal prolapsed