With the widespread acceptance of robot-assisted surgery for reconstructive procedures such as radical prostatectomy and partial nephrectomy, the next frontier for urologic robotic-assisted surgery appears to be in the female pelvis.
J. Stuart Wolf, Jr, MDWith the widespread acceptance of robot-assisted surgery for reconstructive procedures such as radical prostatectomy and partial nephrectomy, the next frontier for urologic robotic-assisted surgery appears to be in the female pelvis.
Related: Robotic prolapse repair safe, durable
A group of fellowship-trained surgeons from Beaumont Hospital in Royal Oak, MI recently reported their considerable experience with robotically assisted pelvic organ prolapse repair, which is highlighted in a recent Urology Timesarticle. Among the 197 procedures, almost all were sacrocolpopexy. Most patients were discharged from the hospital the day after surgery.
The intra-operative complication and early postoperative complication rates were quite acceptable. There was a 21% rate of grade 2 or 3 recurrent pelvic organ prolapse, but only a 4.8% rate of repeat repair. Despite being an abdominal (as opposed to vaginal) procedure, there was still a mesh exposure rate of 9.8%. It is reassuring to note, however, that fewer than half of the patients with mesh exposure required surgical revision.
It was hoped that the abdominal approach might reduce the rate of mesh complications compared to a vaginal approach, but this does not appear to be the case. Although the FDA warning about mesh for pelvic organ prolapse repair pertains to transvaginal use, appropriate counseling of patients before any use of mesh is encouraged.
There certainly appears to be a role for robot-assisted pelvic organ prolapse repair, but long-term studies are vital to assess the best role for this procedure.
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