Surgical management of apical pelvic support defects: the impact of robotic technology.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Our aim was to determine what effect access to robotic technology had on our approach to managing apical pelvic support defects. METHODS: This was a retrospective chart review of 187 pelvic floor reconstructive surgeries performed for the 18 months prior to (time period 1 January 2007 to July 2008) and following (time period 2 July 2009 to December 2009) the introduction of the robot. Chi-square was used to compare percentages, and analysis of variance (ANOVA) was used to compare demographic data among groups. RESULTS: Overall, 187 procedures were performed for apical prolapse during the study period 61 in time period 1 and 126 in time period 2. Following the introduction of robotic technology, a significant change from vaginal to abdominal reconstruction occurred. Uterosacral ligament suspension declined from 67 % to 22 % (p < 0.0001), whereas sacrocolpopexy increased from 25 % (15/61) to 66 % (83/126) (p < 0.0001). The rate of abdominal sacrocolpopexy, however, declined from 25 % (15/61) to 2 % (2/126) over the two time periods (p < 0.0001). CONCLUSION: The introduction of robotic technology significantly affected the surgical procedure and mode of surgical access for repair of apical pelvic support defects.