Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse

Introduction and hypothesis

Open abdominal sacrocolpopexy has been the preferred treatment for post-hysterectomy vaginal vault prolapse. In light of the rise in popularity of less invasive robotic sacrocolpopexy, our objective was to compare perioperative complications of robotic vs open sacrocolpopexy.

Methods

This was a single-institution, retrospective cohort study of robotic and open sacrocolpopexies. Robotic sacrocolpopexies performed between 1 January 2007 and 31 December 2009 were compared with open cases performed between 1 January 2002 and 31 December 2006. Baseline and intraoperative variables of the groups were compared. Complications were compared univariately and in a multivariable logistic regression model to adjust for prior transabdominal surgery.

Results

A total of 50 robotic and 87 open sacrocolpopexies were analyzed. Baseline characteristics were similar, but patients in the open group had more prior transabdominal surgeries. The robotically assisted group had decreased estimated blood loss (median, 100 mL vs 150 mL; P?=?0.002) and hospital stay (median, 2 days vs 3 days; P?P?P?=?0.02), and vaginotomy (24.0 % [12 out of 50] vs 5.7 % [5 out of 87]; P?=?0.003). Two patients in the robotically assisted group had postoperative hernia. There were no differences in rates of ureteral or bowel injury, urinary tract infection, ileus, bowel obstruction, or overall complications.

Conclusions

Overall complication rates of robotic and open sacrocolpopexy were not significantly different. The robotically assisted group experienced shorter hospital stay but increased operative times and increased incidence of cystotomy and vaginotomy, possibly reflecting the learning curve of robotic sacrocolpopexy.     

Comparison of pronator tenotomy and pronator rerouting in children with spastic cerebral palsy

Forty-one patients with cerebral palsy and pronation contracture of the forearm were treated with pronator teres rerouting compared with 16 patients who were treated with pronator teres tenotomy. The mean age of patients with pronator tenotomy was 4 years 3 months compared with 7 years 3 months for patients with rerouting. Follow-up averaged 94 months for tenotomy and 21 months for rerouting. Average gain in supination was 78 degrees for rerouting and 54 degrees for tenotomy. No patient lost active range of motion during follow-up. Although pronator teres tenotomy increased active supination of the forearm, greater active supination of the forearm was afforded patients treated with pronator teres rerouting.