Nazema Y. Siddiqui

Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy.

OBJECTIVE: To compare short-term outcomes of robotic sacrocolpopexy with abdominal sacrocolpopexy for vaginal vault prolapse. METHODS: We conducted a retrospective cohort study comparing robotic to abdominal sacrocolpopexy with placement of permanent mesh. The primary outcome was vaginal vault support on 6-week postoperative pelvic organ prolapse quantification (POP-Q) system examination. Secondary outcomes included blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, postoperative fever, pneumonia, wound infection, and urinary retention. RESULTS: The analysis included 178 patients (73 robotic and 105 abdominal sacrocolpopexy). There were no differences in age, race, or body mass index. Robotic sacrocolpopexy showed slight improvement on POP-Q “C” point (–9 compared with –8, P=.008) when compared with abdominal sacrocolpopexy and was associated with less blood loss (103±96 mL compared with 255±155 mL, P<.001), longer total operative time (328±55 minutes compared with 225±61 minutes, P<.001), shorter length of stay (1.3±0.8 days compared with 2.7±1.4 days, P<.001), and a higher incidence of postoperative fever (4.1% compared with 0.0%, P=.04). There were no differences in other secondary outcomes. Operative time remained significantly greater in the robotic group (P<.001), and estimated blood loss remained lower (P<.001) when controlling for possible confounders. CONCLUSION: Robotic sacrocolpopexy demonstrated similar short-term vaginal vault support compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and shorter length of stay. Long-term data are needed to assess the durability of this new minimally invasive procedure. LEVEL OF EVIDENCE: II

Efficacy and adverse events of sacral nerve stimulation for overactive bladder: A systematic review.

To systematically review the literature regarding efficacy and adverse events of sacral nerve stimulation (SNS) via the InterStim device for treatment of women with refractory overactive bladder (OAB).

Cost-Minimization Analysis of Robotic-Assisted, Laparoscopic, and Abdominal Sacrocolpopexy

STUDY OBJECTIVE To perform a cost-minimization analysis comparing robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. DESIGN Cost-minimization analysis using a micro-costing approach (Canadian Task Force classification III). MEASUREMENTS AND MAIN RESULTS A decision model was developed to compare the costs (2008 US dollars) of robotic, laparoscopic, and abdominal sacrocolpopexy. Our model included operative time, risk of conversion, risk of transfusion, and length of stay (LOS) for each method. Respective baseline estimates for robotic, laparoscopic, and abdominal sacrocolpopexy procedures included operative time (328, 269, and 170 minutes), conversion (1.4%, 1.8%, and 0%), transfusion (1.4%, 1.8%, 3.8%), and LOS (1.0, 1.8, and 2.7 days). Two models were used, the Robot Existing model, that is, current hospital ownership of a robotic system, and the Robot Purchase model, that is, initial hospital purchase of a robotic system, with purchase and maintenance costs amortized and distributed across robotic procedures. Sensitivity analyses were performed to assess the effect of varying each parameter through its range. For the Robot Existing robot model, robotic sacrocolpopexy was the most expensive,

Symptomatic and anatomic 1-year outcomes after robotic and abdominal sacrocolpopexy

8508 per procedure compared with laparoscopic sacrocolpopexy at

Mesh Sacrocolpopexy Compared With Native Tissue Vaginal Repair: A Systematic Review and Meta-analysis

7353 and abdominal sacrocolpopexy at

Cost-Effectiveness of Sacral Neuromodulation Versus Intravesical Botulinum A Toxin for Treatment of Refractory Urge Incontinence

5792. Robotic and laparoscopic sacrocolpopexy became cost-equivalent only when robotic operative time was reduced to 149 minutes, robotic disposables costs were reduced to

Nonsurgical management of heavy menstrual bleeding: a systematic review.

2132, or laparoscopic disposable costs were increased to

Sling revision/removal for mesh erosion and urinary retention: long-term risk and predictors

3413. Laparoscopic and abdominal sacrocolpopexy became cost-equivalent only when laparoscopic disposable costs were reduced to

Long-Term Outcomes After Stress Urinary Incontinence Surgery

668, mean LOS for abdominal sacrocolpopexy was increased to 5.6 days, or surgeon reimbursement for abdominal sacrocolpopexy exceeded

Cost-Effectiveness of Botulinum Toxin A Versus Anticholinergic Medications for Idiopathic Urge Incontinence

2213. The addition of robotic purchase and maintenance costs resulted in an incremental increase of