"Quality of Life Outcomes After 100 da Vinci Robotic Sacrocolpopexy"

Conference Name: 37th Annual Meeting of the Society of Gynecologic Surgeon's (SGS) Scientific Meeting

Authors: Leah Lillmars; Renae Conner; Beth Wiegand; Theresa Bacon-Baguley, PhD, Samir Hamati, MD

Objectives:

Over the past fifty years the approach to sacrocolpopexy has evolved from an open abdominal, to laparoscopic and finally to a robotic approach. The da Vinci approach has been reported to have less blood loss, shorter length of stay when compared to an abdominal approach (1). Despite these reported benefits, no reported research was found on the quality of life after da Vinci sacrocolpopexy. The objective of this study was to compare pre-surgical and post-surgical quality of life outcomes pertaining to bladder, bowel and vaginal symptoms after da Vinci sacrocolpopexy.

Reference

1) Geller, E.J., Siddiqui, N.Y., Wu, J.M., Visco, A.G. 2008. Short-Term Outcomes of Robotic Sacrocolpopexy Compared With Abdominal Sacrocolpopexy. Obsetet & Gynecol 112(6):1201-1206.

Materials and Methods

The sample used consisted of 100 patients who had daVinci sacrocolpopexy between October- 2007 and March-2010. The subjects were mailed the PFIQ-20 and two versions of the PFIQ-7. One version of the PFIQ-7 was to identify quality of life measures before the surgery. The second version was to identify quality of life measures after the surgery. Two additional questions were included in the mailings. The questions asked: Overall, how do you feel in terms of your prolapse since your surgery? and Would you choose to have the surgery again? In addition, there was a qualitative question that allowed the subject to elaborate on why they would not choose to have the surgery again.

Results
A total of 57 patients (57%) returned the surveys. The age range at the time of surgery was between 40 and 83 years old. The average BMI was 27.5. Using the Wilcoxon SignedRank test, a significant decrease in symptoms was found when comparing the pre-surgical summary scores of the PFIQ-7 (mean 58.98) to the post-surgical summary scores (mean 19.88) (p<001). The pre-surgical mean bladder symptoms (mean 25.42) showed a significant decrease when compared to the post-surgical bladder symptoms (mean 10.37) (p<.001). Also, a significant decrease was found between the pre-surgical (12.33) and post-surgical (5.10) bowel symptoms (p=.007). Lastly, a significant decrease was found between the pre-surgical (21.89) and post-surgical (4.69) vaginal symptoms (p<.001). The result of the PFIQ-20 identified that 51.8% of the subjects had no complaints of vaginal prolapse symptoms following surgery, 30.4% had no colorectal symptoms, 26.8% had no urinary complaints. According to the added questions, 96.4% identified that they had improvement or marked improvement after the surgery. No patients reported to be worse or markedly worse after the surgery, and 94.7% reported that they would have the surgery all over again.

Conclusion

The results of this study show a significant increase in the quality of life (measured by a decrease in symptoms) after da Vinci sacrocolpopexy in all three areas assessed by the PFIQ-7: bladder, bowel and vaginal symptoms, as well as a significant overall improvement. In addition, an overwhelming amount of patients (95%) stated that they would have the surgery again.