Objectives: The primary objective was to compare perioperative complications after robotic surgery (RS) versus vaginal surgery (VS) for apical prolapse repair in elderly women. The secondary objectives were to (1) assess whether tools designed to predict surgical morbidity, the American Society of Anesthesiologists (ASA) class and the Charlson Comorbidity Index (CCI), are useful in the elderly urogynecologic population and (2) to classify complications during urogynecologic apical procedures using the Dindo classification system.
Methods: We reviewed medical records of women 65 years or older who underwent RS or VS between March 2006 and April 2011. Procedures included robotic sacrocolpopexy and sacrocervicopexy, vaginal uterosacral ligament suspension, sacrospinous ligament suspension, colpocleisis, and Uphold vaginal mesh placement. We assessed preoperative risks using ASA and CCI classification and complications using Dindo grade.
Results: There were 136 eligible cases (RS, 70; and VS, 66) during the 5-year study period. Women who underwent RS were younger (70 vs 74 years; P < 0.001). Vaginal surgery had more severe comorbidities as measured by the CCI (P = 0.012) but similar ASA profiles (P = 0.10). Robotic surgery had longer operative times (P < 0.001) but a lower estimated blood loss (P < 0.001). There were fewer postoperative complications in RS (P = 0.005). However, complication severity based on Dindo grade was similar between RS and VS, with most surgeries having no complications.
Conclusions: In the elderly women, RS was associated with fewer postoperative complications than VS. Overall, all procedures were associated with few complications, and either route may be reasonable in the elderly population.
Robotic surgery may be a good alternative to vaginal reconstructive surgery for elderly women with demonstrated preoperative morbidity.
From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA; and †Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC.
Reprints: Barbara L. Robinson, MD, Georgia Regents University, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Georgia Regents University, 1120 15th St, BB 7514B, Augusta, GA 30912. E-mail: email@example.com.
Drs Geller and Matthews have received honoraria for speaking at symposia sponsored by Intuitive Surgical. Dr Parnell is a proctor for Intuitive Surgical.