From the Guidelines
Robotic sacrocolpopexy is considered an intermediate-risk procedure. This classification is based on the procedure's invasiveness, potential for complications, and recovery requirements, as well as the need for general anesthesia and potential for deep vein thrombosis (DVT) formation, as suggested by the American Urological Association's best practice statement for the prevention of DVT in patients undergoing urologic surgery 1. As a minimally invasive approach to treating pelvic organ prolapse, robotic sacrocolpopexy involves attaching surgical mesh to the vaginal vault and securing it to the sacrum using robotic assistance. The intermediate risk classification means that while it carries more risk than minor outpatient procedures, it presents less risk than major open abdominal or cardiac surgeries. Some key points to consider include:
- The need for DVT prophylaxis, as the rates of DVT in patients undergoing major gynecologic surgery in the absence of DVT prophylaxis are reported to be as high as 6% to 29% 1
- The potential for complications, including mesh erosion, infection, bleeding, and injury to surrounding structures
- The advantages of the robotic approach, including smaller incisions, less blood loss, shorter hospital stays, and faster recovery times compared to traditional open sacrocolpopexy. Key considerations for preoperative planning include:
- Appropriate patient counseling regarding the risks and benefits of the procedure
- Anesthesia considerations, including the need for general anesthesia
- Perioperative management, including DVT prophylaxis and postoperative care.
From the Research
Risk Classification of Robotic Sacrocolpopexy
The risk classification of robotic sacrocolpopexy can be determined by analyzing the complication rates and outcomes reported in various studies.
- The overall complication rates for robotic sacrocolpopexy are relatively low, with intraoperative complications occurring in 2.7% of patients and postoperative complications occurring in 13.0% of patients 2.
- The conversion rate to open surgery is less than 1% 3, and the mesh erosion rate is around 2% 3, 4.
- Serious complication rates are low but not rare, with bowel injury, readmission rate, wound infection, and postoperative hernia at port site occurring in less than 3% of patients 5.
Comparison with Other Surgical Approaches
Robotic sacrocolpopexy has been compared to laparoscopic sacrocolpopexy in several studies, with no significant differences observed in perioperative transfusion, intraoperative and postoperative complications, or objective recurrence between the two approaches 2, 6.
- However, robotic sacrocolpopexy was associated with significantly lower blood loss and lower conversion rate compared to laparoscopic sacrocolpopexy 2.
- The operative time was longer for robotic sacrocolpopexy compared to laparoscopic sacrocolpopexy 2.
Conclusion on Risk Level
Based on the available evidence, robotic sacrocolpopexy can be considered an intermediate-risk procedure, with a relatively low risk of serious complications but a higher risk of minor complications and longer operative times compared to other surgical approaches 2, 6, 3, 5, 4.