Perioperative adverse events after minimally invasive abdominal sacrocolpopexy


      Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events.

      Study Design

      This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data.


      Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m2. The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not.


      Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hendrix S.L.
        • Clark A.
        • Nygaard I.
        • et al.
        Pelvic organ prolapse in the women's health initiative: gravity and gravidity.
        Am J Obstet Gynecol. 2002; 186: 1160-1166
        • Jelovsek J.E.
        • Barber M.D.
        Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life.
        Am J Obstet Gynecol. 2006; 194: 1455-1461
        • Ganatra A.M.
        • Rozet F.
        • Sanchez-Salas R.
        • et al.
        The current status of laparoscopic sacrocolpopexy: a review.
        Eur Urol. 2009; 55: 1089-1103
        • Maher C.
        • Feiner B.
        • Baessler K.
        • Schmid C.
        Surgical management of pelvic organ prolapse in women.
        Cochrane Database Syst Rev. 2013; 4: CD004014
        • Benson J.T.
        • Lucente V.
        • McClellan E.
        Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation.
        Am J Obstet Gynecol. 1996; 175: 1418-1421
        • Geller E.J.
        • Parnell B.A.
        • Dunivan G.C.
        Robotic vs abdominal sacrocolpopexy: a 44-month pelvic floor outcomes.
        Urology. 2012; 79: 532-536
        • Walters M.D.
        • Ridgeway B.M.
        Surgical treatment of vaginal apex prolapse.
        Obstet Gynecol. 2013; 121: 354-373
        • Ploumidis A.
        • Spinoit A.F.
        • Naeyer G.D.
        • et al.
        Robot-assisted sacrocolpopexy for pelvic organ prolapse: surgical technique and outcomes at a single high-volume institution.
        Int Urogynecol J. 2014; 65: 138-145
        • Germain A.
        • Thibault F.
        • Galifert M.
        • et al.
        Long-term outcomes after totally robotic sacrocolpopexy for treatment of pelvic organ prolapse.
        Surg Endosc. 2013; 27: 525-529
        • Siddiqui N.Y.
        • Geller E.J.
        • Visco A.G.
        Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy.
        Am J Obstet Gynecol. 2012; 206: 435.e1-435.e5
        • Geller E.J.
        • Parnell B.A.
        • Dunivan G.C.
        Pelvic floor function before and after robotic sacrocolpopexy: one year outcomes.
        J Minim Invasive Gynecol. 2011; 18: 322-327
        • Seror J.
        • Yates D.R.
        • Seringe E.
        • et al.
        Prospective comparison of short-term functional outcomes obtained after pure laparoscopic and robot-assisted laparoscopic sacrocolpopexy.
        World J Urol. 2012; 30: 393-398
        • Khan A.
        • Alperin M.
        • Wu N.
        • et al.
        Comparative outcomes of open versus laparoscopic sacrocolpopexy among Medicare beneficiaries.
        Int Urogynecol J. 2013; 24: 1883-1891
        • Chan C.M.
        • Liang H.H.
        • Go W.W.
        • et al.
        Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical and functional outcomes.
        Hong Kong Med J. 2011; 17: 301-305
        • Tan-Kim J.
        • Menefee S.A.
        • Luber K.M.
        • et al.
        Robotic-assisted and laparoscopic sacrocolpopexy: comparing operative times, costs and outcomes.
        Female Pelvic Med Reconstr Surg. 2011; 17: 44-49
        • Price N.
        • Slack A.
        • Jackson S.R.
        Laparoscopic sacrocolpopexy: an observational study of functional and anatomical outcomes.
        Int Urogynecol J. 2011; 22: 77-82
        • Paraiso M.F.
        • Jelovsek J.E.
        • Frick A.
        • Chen C.C.
        • Barber M.D.
        Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial.
        Obstet Gynecol. 2011; 118: 1005-1013
        • Freeman R.M.
        • Pantazis K.
        • Thomson A.
        • et al.
        A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study.
        Int Urogynecol J. 2013; 24: 377-384
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Paraiso M.F.R.
        • Walters M.D.
        • Rackley R.R.
        • Melek S.
        • Hugney C.
        Laparoscopic and sacral colpopexies: a comparative cohort study.
        Am J Obstet Gynecol. 2005; 192: 1752-1758
        • Mueller E.R.
        • Kenton K.
        • Tarnay C.
        • et al.
        Abdominal colpopexy: comparison of endoscopic surgical strategies (ACESS).
        Contemp Clin Trials. 2012; 33: 1011-1018
        • Awad N.
        • Mustafa S.
        • Amit A.
        • et al.
        Implementation of a new procedure: laparoscopic versus robotic sacrocolpopexy.
        Arch Gynecol Obstet. 2013; 287: 1181-1186
        • Brubaker L.
        • Nygaard I.
        • Richter H.E.
        • et al.
        Two-year outcomes after sacrocolpopexy without and without Burch to prevent stress urinary incontinence.
        Obstet Gynecol. 2008; 112: 49-55
        • Propst K.
        • Tunitsky-Bitton E.
        • Schimpf M.O.
        • Ridgeway B.
        Pyogenic spondylodiscitis associated with sacral colpopexy and rectopexy: report of two cases and evaluation of the literature.
        Int Urogynecol J. 2014; 25: 21-31