V2-05: Surgical technique, surgical benchmarks and impact of team constancy on surgical duration in robot-assisted isolated sacrocolpopexy and sacrocolpopexy combined with modified Burch colposuspension procedure. Experience in one institution in 120 cases

Video

Introductions and Objectives
To describe our technique and to report intra- and postoperative bench-marks of robot-assisted isolated sacrocolpopexy and sacrocolpopexy combined with modified Burch colposuspension procedure. The video shows all steps of the procedure in detail: from port placement (five-port transperitoneal approach) over dissection of vesicovaginal and rectovaginal spaces to the suture of a Y-shaped piece of synthetic mesh to the vagina and promontory.

Methods
We enrolled 120 consecutive patients in this observational study. We assessed surgery duration, console duration, blood loss, intra- and postoperative complications. We described frequencies as number and/or percent and continuous data as mean (standard deviation, SD) as appropriate. We also calculated the correlation between the total and console duration and centre experience by linear regression.

Results
: The mean age was 69,2 (SD 10,9) years, the mean BMI 26.8 (SD 5.2). Eighty-four (70%) patients were ASA 1-2, 35 (29,2 %) ASA 3 and one was ASA 4 (0,8%). Seventy-seven (76.2%) women had undergone previous abdominal surgery. Seventy-three (60,8%) of the patient had a previous history of hysterectomy (abdominal or vaginal). All procedures could be conducted without conversion to open surgery. Intraoperative complications occurred in six cases (5,0 %): superficial lesions (serosa) of the bowel in three cases and lesion of the bladder in other 3 cases. The overall mean surgery duration was 104 minutes (SD29,8), thereof 69,2 (SD27,0) minutes console time. The mean blood loss amounted to 32 ml (SD 38,6). The mean console duration was 56,9 minutes (SD22,8) in patients with isolated sacrocolpopexy and 86,7 minutes (SD23,3) in combined sacrocolpopexy and modified Burch colposuspension procedure (p=0.003). There was a significant correlation between duration and centre experience for total surgery time (R0.610, p
Conclusions
Both robot-assisted isolated sacrocolpopexy and combined sacrocolpopexy modified Burch colposuspension were safe procedures, resulted in minimal blood loss and were feasible within moderate surgery duration. Surgery duration reduction in our centre solely depended on console surgeon experience.

Funding: none