Long-term outcomes after robotic sacrocolpopexy in pelvic organ prolapse: prospective analysis.

OBJECTIVE: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. METHODS: We conducted a prospective analysis of our series of robotic sacrocolpopexy. INCLUSION CRITERIA: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. RESULTS: 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. CONCLUSIONS: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.

[Effect of recipient age on transplants performed using organs from donors in asystole]. / Influencia de la edad del receptor en el trasplante realizado con órganos procedentes de donantes en asistolia.

OBJECTIVES: To evaluate the influence of receptor's age on the outcomes of kidney transplants with organs from non heart beating donors. METHODS: Observational study of the historic cohort of 570 kidney transplants performed at the Hospital Clínico San Carlos between 1991 and 1999. Receptor's were divided into two age groups, group 1 younger than 50 years, and group 2 older than 50 years. All organs where harvested from non heart beating donors. RESULTS: We studied 110 kidney transplants coming from non heart beating donors; 52 belonged to group 1, and 57 to group 2. Three-year patient survival for receptor's younger than 50 years was 100%. The probability of three-year survival for receptor's older than 50 years was 79.39% (p 0.07). Graft survival was 88.46%, 86.54%, and 86.54% at 12, 24, and 36 months respectively for receptor's younger than 50 years. When receptors were older than 50 years the probability of functioning graft in the same periods of time was 89.20%, 89.20%, and 86.32% respectively. CONCLUSIONS: Receptor's age doesn't seem to influence graft survival when kidneys from non heart beating donors are used.