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Patient Experience with Enhanced Recovery and Early Discharge for Minimally Invasive Sacrocolpopexy: A Qualitative Study
S78 operative outcomes associated with R-ASCPP compared to robotic-assisted sacrocolpopexy (R-ASCP) with concomitant vaginal prolapse repair. Design: Retrospective cohort study. Setting: Academic-affiliated community hospital. Patients or Participants: Cases of R-ASCPP were compared to R-ASCP with concomitant anterior-posterior (A/P) compartmental repair controls between January 2013 and January 2019. A total of 126 women were identified. Interventions: N/A Measurements and Main Results: Cases of R-ASCPP (n=83) were compared to matched R-ASCP with A/P repair controls (n=43) in 2:1 ratio. Total operative time was 36 minutes shorter on average for cases (214mins vs. 250mins, p<0.05), with similar quantitative blood loss between groups (1.8g/dL vs. 2.1g/dL, p=0.61). Both cases and controls had similar narcotic requirements in the post-anesthesia care unit (1.72MME vs 2.13MME, p=0.59) and the entire hospital admission (17.30MME vs. 20.79MME, p=0.81). Cases retained larger post-void residual (PVR) bladder volumes (204cc vs. 122cc, p=0.12), with a larger percentage discharged with outpatient catheterization (32.5% vs. 14.3%, p<0.05). Patient demographics were similar among groups. Conclusion: R-ASCPP is a well tolerated procedure, however is associated with a statistically significant propensity for acute urinary retention. Surgeons should consider counseling R-ASCPP patients about the increased incidence for elevated PVRs requiring either intermittent or indwelling catheterization. Future investigation is warranted to better understand, prevent, and treat this increased incidence in a large population of R-ASCPP patients. Open Communications 21: Urogynecology (3:05 PM − 4:05 PM) 3:19 PM Patient Experience with Enhanced Recovery and Early Discharge for Minimally Invasive Sacrocolpopexy: A Qualitative Study Snook L,1,* Evans S,1 Abimbola O,2 Yates T,1 Myers EM3. 1Atrium Health, Charlotte, NC; 2School of Medicine, University of North Carolina, Chapel Hill, NC; 3Obstetrics and Gynecology, Division of Female Pelvic Reconstructive Surgery, Atrium Health, Charlotte, NC *Corresponding author. Study Objective: To describe and compare patients’ experiences with same-day versus next-day discharge after minimally invasive sacrocolpopexy within an enhanced recovery protocol. Design: Qualitative study using semi-structured interviews. Setting: Academic institution. Patients or Participants: Patients undergoing minimally invasive sacrocolpopexy within an enhanced recovery protocol − discharged the same day as surgery (n=7) or the day following surgery (n=7). Interventions: Interviews were conducted between December 2018-February 2019, 2 to 6 weeks after hospital discharge. Topics included: patient preparedness, preoperative education, physical and emotional recovery, and overall perception of the enhanced recovery protocol. Interviews were audio-recorded, transcribed, and analyzed thematically. Investigators utilized a grounded theory approach in identifying emergent themes and concepts until saturation was achieved. Measurements and Main Results: Patients discharged same day spent more time in the post-anesthesia care unit (314.4 vs 79.7 minutes, p<0.01) and were more likely to be discharged with a catheter (85.7 vs 14.3%, p=0.03). There were no other differences in demographic or procedural characteristics between groups. Less than half of participants (n=6) were aware they were part of an enhanced recovery protocol. Both groups felt well-informed about their procedures, prepared for what to expect perioperatively, and supported by providers. Both reported positive experiences with physical and emotional at-home recovery. Same-day discharge patients denied a desire to stay in the hospital longer. At-home support was an important consideration. Neither group reported major physical problems post-discharge. Same-day discharge
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 patients spoke frequently about the challenges of returning home with a catheter, cited by some as a reason to stay in the hospital longer. Conclusion: Although few participants realized they were part of a protocol, all reported benefit from enhanced recovery after minimally invasive sacrocolpopexy. Screening for the availability of a caregiver and providing information regarding postoperative catheter management are likely important to ensure successful compliance with early discharge goals. Open Communications 21: Urogynecology (3:05 PM − 4:05 PM) 3:26 PM Laparoscopic Uterosacral Ligament Suspension with the Use of Barbed Suture Rodger JD,* Pugh CJ. Obstetrics and Gynecology, Reading Hospital, West Reading, PA *Corresponding author. Video Objective: To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension Setting: I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Interventions: Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Conclusion: Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity. Open Communications 21: Urogynecology (3:05 PM − 4:05 PM) 3:33 PM Surgical Correction of Obstructed Defecation Syndrome Cui T,* Matthews CA. Urology, Wake Forest School of Medicine, Winston Salem, NC *Corresponding author. Video Objective: Obstructed defecation syndrome (ODS) is a form of colonic constipation in which stool cannot effectively be evacuated from the rectum. ODS is usually caused by a combination of behavioral, functional, and anatomic factors. While many women with ODS can experience improvement with aggressive medical management, the anatomic contribution what we term a “posterior” enterocele to defecation obstruction can be significant.
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 patients spoke frequently about the challenges of returning home with a catheter, cited by some as a reason to stay in the hospital longer. Conclusion: Although few participants realized they were part of a protocol, all reported benefit from enhanced recovery after minimally invasive sacrocolpopexy. Screening for the availability of a caregiver and providing information regarding postoperative catheter management are likely important to ensure successful compliance with early discharge goals. Open Communications 21: Urogynecology (3:05 PM − 4:05 PM) 3:26 PM Laparoscopic Uterosacral Ligament Suspension with the Use of Barbed Suture Rodger JD,* Pugh CJ. Obstetrics and Gynecology, Reading Hospital, West Reading, PA *Corresponding author. Video Objective: To demonstrate the use of unidirectional barbed suture to perform uterosacral ligament suspension Setting: I.L. is a 49 year old G5P4014 who initially presented to her primary provider with complaints of urinary discomfort and cervical prolapse. At rest, her cervix rested at the introitus and with valsalva, the cervix rested 2cm beyond the introitus. Her POP-Q examination was significant for Stage 3 anterior prolapse and Stage 2 apical prolapse. She has a past surgical history significant for a supracervical hysterectomy, bilateral salpingectomy which was performed in 2010 for menorrhagia and dysmenorrhea. Patient was referred to Urogynecology for treatment. Interventions: Patient underwent a laparoscopic trachelectomy, anterior/posterior repair, uterosacral ligament suspension, and cystoscopy. After trachelectomy is performed, the vaginal cuff is closed using a unidirectional barbed suture. Using K-technique, each angle of the vaginal cuff is then sutured to the ipsilateral uterosacral ligament. Successful uterosacral ligament suspension of the vaginal cuff was achieved. Ureteral patency was confirmed by cystoscopy at the end of the procedure via cystoscopy. Conclusion: Uterosacral ligament suspension is an effective procedure for the treatment of pelvic organ prolapse and the use of barb suture aids with the ease of this procedure as laparoscopic knot tying can be highly challenging. The K-technique has been shown to be an effective method of closing the vaginal cuff with 2 unidirectional barbed sutures. A case series examining this technique has shown a decreased rate of complications, such as ureteral or sacral nerve injury. Uterosacral ligament suspension has long been used for the treatment of pelvic organ prolapse, however, by implementing the use of unidirectional barbed suture the ease with which this procedure can be performed can be increased while also decreasing the risk of complications and morbidity. Open Communications 21: Urogynecology (3:05 PM − 4:05 PM) 3:33 PM Surgical Correction of Obstructed Defecation Syndrome Cui T,* Matthews CA. Urology, Wake Forest School of Medicine, Winston Salem, NC *Corresponding author. Video Objective: Obstructed defecation syndrome (ODS) is a form of colonic constipation in which stool cannot effectively be evacuated from the rectum. ODS is usually caused by a combination of behavioral, functional, and anatomic factors. While many women with ODS can experience improvement with aggressive medical management, the anatomic contribution what we term a “posterior” enterocele to defecation obstruction can be significant.