The American Urogynecologic Society/The Society of Gynecologic Surgeons
Laparoscopic and abdominal sacral colpopexies: A comparative cohort study

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Objective

This study was undertaken to compare laparoscopic and open sacral colpopexies for efficacy and safety.

Study design

Charts were reviewed for 56 patients who underwent laparoscopic sacral colpopexy and 61 patients who underwent open sacral colpopexy. Demographic and hospital data, complications, and follow-up visits were reviewed.

Results

Mean follow-up was 13.5 ± 12.1 months and 15.7 ± 18.1months in the laparoscopic and open groups, respectively. Mean operating time was significantly greater in the laparoscopic versus open cohort, 269 ± 65 minutes and 218 ± 60 minutes, respectively (P < .0001). Estimated blood loss (172 ± 166 mL vs 234 ± 149 mL; P = .04) and hospital stay (1.8 ± 1.0 days vs 4.0 ± 1.8 days; P < .0001) were significantly less in the laparoscopic group than the open group. Complication and reoperation rates were similar.

Conclusion

Laparoscopic and open sacral colpopexies have comparable clinical outcomes. Although laparoscopic sacral colpopexy requires longer operating time, hospital stay is significantly decreased.

Section snippets

Material and methods

The Institutional Review Board of the Cleveland Clinic Foundation approved this investigation. Primary surgeons who performed laparoscopic and open sacral colpopexies produced surgical logs of consecutive cases of patients with posthysterectomy vaginal prolapse who underwent these procedures from late 1998 through 2003. Patient data were extracted from available paper charts and computerized charts, which were instituted in 2001. Data obtained included demographics, previous and concurrent

Results

The demographic data are shown in Table I and did not differ between groups. The majority of patients in both groups had undergone previous surgery for urinary incontinence and/or pelvic organ prolapse. Previous reconstructive pelvic surgery included anterior repairs, bladder neck suspensions, sling procedures, retropubic colposuspensions (Burch and PVDRs), enterocele repairs, culdeplasties, posterior repairs, vaginal vault suspensions (iliococcygeus, sacrospinous, or uterosacral vaginal vault

Comment

To our knowledge, this is the first study comparing laparoscopic sacral colpopexy to the conventional open technique. The remaining literature regarding this procedure consists of case series with short-term follow-up. Our investigation demonstrates that laparoscopic and open sacral colpopexies have comparable clinical outcomes. Because of our relatively small sample size, we are unable to comment definitively on differences in complications between the 2 procedures. A post hoc power

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Presented at the Joint Scientific Meeting of the Society of Gynecologic Surgeons and the American Urogynecologic Society, San Diego, Calif, July 29-31, 2004.

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