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Robotic Sacrospinous Ligament Suspension
S88 Setting: The medical device used was a compound of pure, fluid, translucent and sterile n-hexyl cyanoacrylate monomers (IFABOND, Peters Chirurgical, France). The glue is applied by means of a cannula. Patients or Participants: 45 patients were included from June 2015 to February 2017, with stage 2-4 genital prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) classification. Interventions: A modified laparoscopic sacrocolpopexy using a liquid adhesive solution to fix the prosthesis to the vagina and to the levator ani was performed. Two non-absorbable sutures were performed to attach the anterior prosthesis to the isthmus and promontory. Measurements and Main Results: The average operating time was 102.5 minutes (40-210 min) and the average hospitalization time was 2.6 days (0-5 days). At one year, clinical examination and questionnaires were available for 33 and 37/45 patients, respectively (73.3 and 82.2%). The analysis of the PFDI 20 questionnaire revealed an improvement in quality of life with an overall score of 41.5/300 one year after surgery vs 106.3/300 preoperatively (p<0.001). No complications occurred during the procedure or prosthetic exposure during the one-year follow-up. The one-year anatomical success rate (POP-Q < 2) was 29/33 (87.9%). The overall satisfaction rate at one was 93.5%. Conclusion: The use of a liquid adhesive solution for prosthetic bonding during sacrocolpopexy appears safe and effective at one year with an improvement in the patient’s satisfaction and overall quality of life. Open Communications 25: Urogynecology (4:10 PM − 5:10 PM) 4:45 PM Comparison of 30-Day Complication Rate Between Minimally Invasive Hysterectomy with and Without Concomitant Urogynecologic Procedure Griebel L,1,* Chapman G,2 Mahajan S,1 Billow M,1 El-Nashar S,3 Dizon AM4. 1University Hospitals Cleveland Medical Center, Cleveland, OH; 2University Hospitals Cleveland Medical Center/MetroHealth Medical Center, Cleveland, OH; 3Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; 4Division of Minimally Invasive Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH *Corresponding author. Study Objective: Primary objective was to evaluate risk of perioperative complications when performing concomitant urogynecologic surgery at time of minimally invasive hysterectomy for large uterus (>250gm). Design: Retrospective cohort study of existing national database. Patients were followed for complications 30 days after hysterectomy. Setting: Data was extracted from the NSQIP database. Patients or Participants: Patients were included who underwent laparoscopic or vaginal hysterectomy for benign indications with uterine weight of at least 250gm from 2014-2017. Patients with gynecologic malignancy and those who underwent abdominal hysterectomy were excluded. The total cohort included 7,428 patients. Interventions: We assessed the effect of concomitant urogynecologic procedure on 30 day complication rates after laparoscopic or vaginal hysterectomy for large uterus (>250gm). Measurements and Main Results: Chi-square analysis and Student’s t-test were used to describe the population and compare groups. Primary outcome was composite rate of all 30 day complications. Stepwise backward multivariate logistic regression was used to control for confounders of the primary outcome. 301 of the 7,428 total patients (4.1%) underwent concomitant urogynecologic procedures. This population was older (49.7 vs 46.6 years, p<0.001), had lower uterine weight (429.2g vs 489.5g, p<0.001), had lower BMI (30.5 vs 31.5, p=0.02), was more likely to be white, was
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 more likely to have a urogynecologist involved, and was more likely to undergo vaginal hysterectomy. Groups were otherwise similar. With regard to primary outcome, the 30 day complication rate was higher in patients who underwent a concomitant urogynecologic procedure (13.3% vs 9.0%, p=0.02). After controlling for confounders including uterine weight, demographic and medical characteristics, operative time, hysterectomy route, and urogynecologic surgeon, concomitant urogynecologic procedure remained an independent predictor of complications (aOR 1.53, 1.07-2.18, p=0.02). Conclusion: In this retrospective analysis of a large national cohort, the 30 day complication rate was greater than 50% higher when concomitant urogynecologic procedure was performed at the time of minimally invasive hysterectomy for a uterus >250gm. Open Communications 25: Urogynecology (4:10 PM − 5:10 PM) 4:52 PM Robotic Sacrospinous Ligament Suspension Clarizio K,* Elkattah RA. Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL *Corresponding author. Video Objective: To describe a robotic approach for performing a sacrospinous ligament suspension. Setting: A 78 year-old woman presented with stage 3 uterine prolapse with the sole complaint of vaginal pressure. She had no urinary or bowel dysfunction. Her gynecologic surgical history included anterior and posterior vaginal wall mesh-augmented repairs. On examination, she had uterovaginal prolapse with underlying palpable uterus and calcified fibroid and the leading edge of he cervix at +6 cm from the hymen. Anterior, posterior and introital measurements on POP-Q were normal. This represented an isolated stage 3 Uterine Prolapse. Interventions: A robotic hysterectomy with bilateral salpingo-oophorectomy was completed. Uterosacral ligaments were attenuated and could not be utilized for vaginal apical support. Alternatively, a robotic right sacrospinous ligament suspension was attempted successfully. Steps for this procedure include: developing the right pararectal space, identifying the levator ani muscles and sacrospinous ligament followed by suspension of the vaginal cuff to the sacrospinous ligament using resorbable suture. This surgical clip demonstrates the technique. Conclusion: A robotic approach can be utilized for vaginal apical suspension to the sacrospinous ligament when uterosacral ligaments are attenuated. Pelvic floor and sidewall anatomic knowledge is required for successful completion of this procedure. Open Communications 25: Urogynecology (4:10 PM − 5:10 PM) 4:59 PM Prophylactic Laparoscopic Uterosacral Ligament Suspension Davenport ER,* Vennart RM. Obstetrics & Gynecology, Las Vegas Minimally Invasive Surgery, Las Vegas, NV *Corresponding author. Video Objective: To demonstrate the benefit and feasibility of prophylactic uterosacral ligament suspension at time of hysterectomy, in hopes of reducing post-hysterectomy vaginal vault prolapse. Setting: Hospital. Interventions: Hysterectomy and Uterosacral ligament Suspension. Conclusion: Laparoscopic uterosacral ligament suspension may be performed during laparoscopic hysterectomy to reduce the risk of post-hysterectomy vaginal vault prolapse.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 more likely to have a urogynecologist involved, and was more likely to undergo vaginal hysterectomy. Groups were otherwise similar. With regard to primary outcome, the 30 day complication rate was higher in patients who underwent a concomitant urogynecologic procedure (13.3% vs 9.0%, p=0.02). After controlling for confounders including uterine weight, demographic and medical characteristics, operative time, hysterectomy route, and urogynecologic surgeon, concomitant urogynecologic procedure remained an independent predictor of complications (aOR 1.53, 1.07-2.18, p=0.02). Conclusion: In this retrospective analysis of a large national cohort, the 30 day complication rate was greater than 50% higher when concomitant urogynecologic procedure was performed at the time of minimally invasive hysterectomy for a uterus >250gm. Open Communications 25: Urogynecology (4:10 PM − 5:10 PM) 4:52 PM Robotic Sacrospinous Ligament Suspension Clarizio K,* Elkattah RA. Obstetrics and Gynecology, University of Illinois College of Medicine Peoria, Peoria, IL *Corresponding author. Video Objective: To describe a robotic approach for performing a sacrospinous ligament suspension. Setting: A 78 year-old woman presented with stage 3 uterine prolapse with the sole complaint of vaginal pressure. She had no urinary or bowel dysfunction. Her gynecologic surgical history included anterior and posterior vaginal wall mesh-augmented repairs. On examination, she had uterovaginal prolapse with underlying palpable uterus and calcified fibroid and the leading edge of he cervix at +6 cm from the hymen. Anterior, posterior and introital measurements on POP-Q were normal. This represented an isolated stage 3 Uterine Prolapse. Interventions: A robotic hysterectomy with bilateral salpingo-oophorectomy was completed. Uterosacral ligaments were attenuated and could not be utilized for vaginal apical support. Alternatively, a robotic right sacrospinous ligament suspension was attempted successfully. Steps for this procedure include: developing the right pararectal space, identifying the levator ani muscles and sacrospinous ligament followed by suspension of the vaginal cuff to the sacrospinous ligament using resorbable suture. This surgical clip demonstrates the technique. Conclusion: A robotic approach can be utilized for vaginal apical suspension to the sacrospinous ligament when uterosacral ligaments are attenuated. Pelvic floor and sidewall anatomic knowledge is required for successful completion of this procedure. Open Communications 25: Urogynecology (4:10 PM − 5:10 PM) 4:59 PM Prophylactic Laparoscopic Uterosacral Ligament Suspension Davenport ER,* Vennart RM. Obstetrics & Gynecology, Las Vegas Minimally Invasive Surgery, Las Vegas, NV *Corresponding author. Video Objective: To demonstrate the benefit and feasibility of prophylactic uterosacral ligament suspension at time of hysterectomy, in hopes of reducing post-hysterectomy vaginal vault prolapse. Setting: Hospital. Interventions: Hysterectomy and Uterosacral ligament Suspension. Conclusion: Laparoscopic uterosacral ligament suspension may be performed during laparoscopic hysterectomy to reduce the risk of post-hysterectomy vaginal vault prolapse.