Outcomes of Robotic Sacrocolpopexy Using Only Absorbable Suture for Mesh Fixation

• Published in: Female pelvic medicine & reconstructive surgery Vol. 23; no. 1; pp. 13 - 16
• Main Authors: Linder, Brian J, Anand, Mallika, Klingele, Christopher J, Trabuco, Emanuel C, Gebhart, John B, Occhino, John A
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2017
• Subjects: Aged; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Pelvic Organ Prolapse - surgery; Polyglactin 910 - therapeutic use; Retrospective Studies; Robotic Surgical Procedures - methods; Surgical Mesh; Suture Techniques - instrumentation; Treatment Failure
• ISSN: 2151-8378; 2154-4212
• DOI: 10.1097/SPV.0000000000000326

OBJECTIVEThe optimal suture selection for mesh attachment during robotic sacrocolpopexy (RSC) is currently unknown. Here, we sought to evaluate the outcomes of RSC using absorbable sutures for vaginal and sacral mesh attachment.
METHODSWe retrospectively reviewed 132 RSC surgeries that were performed for vaginal vault prolapse in the Division of Gynecologic Surgery at our institution from February 2007 to December 2013. All cases were performed with absorbable suture (polyglactin) for vaginal and sacral mesh fixation. Sacrocolpopexy failure was defined as patients undergoing either repeat prolapse surgery or pessary use for recurrent prolapse. The durability of RSC was assessed via Kaplan-Meier method.
RESULTSThe median age at surgery was 61.1 years (interquartile range [IQR], 55.6–68.2) and the median length of postoperative follow-up was 33 months (IQR, 15.7–57). The median body mass index was 26.5 kg/m (IQR, 24.3–29.7). During follow-up, 10 patients underwent prolapse retreatment. There were 2 apical recurrences, 4 distal anterior recurrences, 2 posterior recurrences, and, in 2 cases, the location was unknown. One apical recurrence was confirmed to be secondary to detachment of the mesh from the sacral promontory. Among those with recurrence, the median time to recurrence was 15.5 months (IQR, 4.22–35.9). Overall, the 1-year and 3-year freedom from repeat surgery rates were 96% and 93%, respectively.
CONCLUSIONSWith a median follow-up of 33 months, the use of absorbable suture for both vaginal and sacral attachments during RSC is effective. Further studies evaluating suture selection and mesh attachment techniques for RSC are needed.