| BackgroundPelvic organ prolapse(POP)is one of the common diseases,with a high incidence in middle-aged and elderly women.With the aging Chinese population and the increasing number of multipara,the incidence rate is increasing year by year.Related epidemiological studies have shown that the incidence will increase to 50%within 30 years.POP patients often have symptoms such as dysuria,urinary incontinence,difficult defecation and dyspareunia which seriously affect the patients’physical and psychological status,quality of life and social activities.According to the severity,clinical treatments for POP include surgical and non-surgical interventions.For patients with degree Ⅱ or above of the pelvic organ prolapse quantification system(POP-Q),surgery is the main treatment.Among many procedures,abdominal sacrocolpopexy(ASC)is considered as the gold standard for vaginal vault prolapse.With the deepening of the minimally invasive concept and the improvement of the public’s aesthetics,laparoscopic sacrocolpopexy(LSC)becomes another option after ASC.There is no difference in anatomical outcome and functional recovery between LSC and ASC,and LSC provides significant advantages in beauty,reduced postoperative pain and incisional hernia,reduced recovery time and surgical complications.So it has been gradually replacing ASC.The da Vinci robotic-assisted sacrocolpopexy(RASC)is another development of new minimally invasive surgery technology.The da Vinci robotic system has EndoWrist surgical instruments and a three-dimensional high-definition field of vision,which greatly improves the accuracy and precision of the operation.Foreign researches have shown that RASC is safe and feasible,and has advantages over LSC in reducing blood loss and postoperative recovery.Due to the late start of robotic surgery in China,there are few domestic reports on the clinical application of the da Vinci robotic system in sacrocolpopexy,and the comparative study with conventional laparoscopic sacrocolpopexy is lacking.Our hospital installed the third-generation da Vinci robotic system Si in June 2014 and it has been widely used in clinical treatment.The surgeons have gained rich experience in robotic-assisted sacrocolpopexy.In this study,we compared the clinical data of da Vinci robotic-assisted sacrocolpopexy and conventional laparoscopic sacrocolpopexy in the treatment of POP,and objectively evaluated their differences,advantages,disadvantages and complications.ObjectiveTo analyze the safety,feasibility of RASC and discussed its long-term benefits and potential application value.Materials and MethodsIn this study,the medical records of 148 POP patients in the First Affiliated Hospital of Zhengzhou University from June 2014 to January 2020 were collected,including 46 patients(robotic group)who underwent RASC and 102 patients(conventional laparoscopic group)who underwent LSC.The general information,perioperative measurements and therapeutic effect of the two groups were compared.The objective cure rate of the two groups was evaluated by the stage of POP-Q 3 months,6 months and 12 months after operation.The subjective cure rate of the two groups was evaluated by the disappearance of subjective symptoms after operation.The functional recovery of pelvic organs and sexual life was evaluated by pelvic floor impact questionnaire-7(PFIQ-7)3 months after operation and pelvic organ prolapse urinary incontinence sexual questionnaire-12(PISQ-12)12 months after operation.SPSS 22.0 software was used for statistical analysis.Quantitative data is expressed as mean± standard deviation(x±s),and qualitative data is expressed as count and percentage[n(%)].Independent sample t-test is used for quantitative data conforming to normal distribution.The Mann-Whitney rank sum test is used for quantitative data not conforming to the normal distribution and ordered classification data.Chi-square test is used for disordered classification data.P<0.05 on both sides was statistically significant.Results1.There was no significant statistical difference between the two groups in general condition and preoperative POP-Q stage.All the surgeries were successfully completed,without conversion to laparotomy.No intraoperative complications occurred in both groups.2.The operative time of the robotic group(163.67±45.66 min)was significantly shorter than that of the conventional laparoscopic group(186.06±53.04 min),with P=0.014.The intraoperative estimated blood loss of the robotic group(43.70±39.52 ml)was significantly less than that of the conventional laparoscopic group(55.35±40.29 ml),with P=0.041.The length of postoperative hospital stay in the robotic group(6.57±4.75 d)was significantly shorter than that in the conventional laparoscopic group(6.49±1.95 d),with P=0.024.There was no significant statistical difference between the two groups in the abdominal pelvic adhesion,postoperative indwelling catheter days and postoperative intestinal exhaust time.3.There were 5 cases(10.87%)of short-term complications and 2 cases(4.35%)long-term complications in the robotic group.There were 11 cases(10.78%)of short-term complications and 2 cases(1.96%)of long-term complications in the conventional laparoscopic group.There was no significant statistical difference in incidence of short-term complications and long-term complications between the two groups(P=0.988;P=0.407).4.In the robotic group,except three landmarks(genital hiatus,perineal body and total vaginal length),all the measurements of POP-Q were significantly improved 3 months after operation.The objective cure rate of robotic group was 97.83%.One case recurred 2 years after operation.In the conventional laparoscopic group,except two landmarks(perineal body and total vaginal length),all the measurements of POP-Q were significantly improved 3 months after operation.The objective cure rate of conventional laparoscopic group was 100%.There was no significant statistical difference in POP-Q between the two groups 3 months,6 months and 12 months after operation.There was no significant statistical difference between the two groups in the objective cure rate(97.83%vs 100%,P=0.135).5.The subjective cure rate of robotic group was 95.65%(44 patients expressed satisfaction).The subjective cure rate of conventional laparoscopic group was 98.04%(100 patients were satisfied).There was no significant statistical difference in subjective cure rate between the two groups(95.65%vs 98.04%,P=0.407).6.In the robotic group,the PFIQ-7 3 months after operation was significantly improved(80.46±11.26 vs 23.35±4.41,P<0.001),and the PISQ-12 12 months after operation was significantly improved(22.70±4.06 vs 34.90±2.12,P<0.001).In conventional laparoscopic group,the PFIQ-7 3 months after operation was significantly improved(82.78±8.38 vs 24.36±5.01,P<0.001),and the PISQ-12 12 months after operation was significantly improved(23.20±3.92 vs 34.10±2.54,P<0.001).There was no significant statistical difference in the scores of PFIQ-7 3 months after operation and PISQ-12 12 months after operation between the two groups(P=0.126;P=0.257).Conclusion1.RASC is a safe and effective alternative treatment for POP,which has the same safety and cure rate as LSC,with fine operation,clear vision and effective reduction of blood loss and postoperative recovery time.2.RASC could significantly reduce the operation time,intraoperative blood loss and postoperative hospital stay compared with LSC.3.According to the mid-term follow-up data,there was no significant difference in the subjective and objective cure rate and postoperative complication rate between LSC and RASC.The anatomical structure,urinary and defecation functions,sexual quality of life of the two groups were significantly improved after operation,with high satisfaction. |
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