Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies

NCT ID: NCT01124916

Last Updated: 2017-01-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 84 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2009-11-30
• Study Completion Date: 2013-03-31

Brief Summary

The purpose of this research is to determine if there is a difference in total costs of care and return to health in women who undergo a laparoscopic abdominal sacrocolpopexy (ASC) compared to those undergoing the same procedure with the assistance of a robot.

Both traditional laparoscopic and robotic assisted laparoscopic approaches have been found to result in shorter hospital stays, decreased blood loss and similar surgical outcomes as compared to open abdominal surgery. The decision to use robotic assistance is typically based on surgeon preference and robot availability. The study will compare the outcomes of cost, quality of life, and return to work among women who undergo a laparoscopic sacrocolpopexy utilizing the robot to those using traditional laparoscopic techniques.

This research study is designed to compare the total costs and treatment success of these two surgical techniques. In addition, the study will compare outcomes of post-operative pain, quality of life, sexual function, return to normal activities and satisfaction with treatment outcome.

Detailed Description

Approximately one in ten women undergoes surgery for prolapse or incontinence in her lifetime. Of these, up to thirty percent require a re-operation for recurrence of their prolapse or incontinence symptoms. It has been estimated one in nine women will undergo a hysterectomy in her lifetime, and up to 10% of these women will require surgery for symptomatic vaginal vault prolapse. The search for the ideal repair for pelvic organ prolapse has led to the invention of several approaches to this problem.

Abdominal sacrocolpopexy (ASC) with synthetic mesh is considered the gold standard in the surgical management of pelvic organ prolapse with anatomic success rates ranging from 90 to 100%. Randomized comparative effectiveness trials and systematic literature reviews demonstrated the anatomic superiority of open ASC compared to vaginal sacrospinous ligament suspension.

Although ASC has the highest anatomic success rates for correcting apical prolapse, it is traditionally done via a laparotomy requiring an abdominal incision. Open technique is associated with more frequent short-term complications, including gastrointestinal.

Minimally invasive approaches to ASC using laparoscopy or robotic assisted laparoscopy demonstrate shorter hospital stays, decreased blood loss, and similar short-term anatomic outcomes when compared to open ASC. Increasing numbers of surgeons and patients choose minimally invasive ASC to maximize the benefits of abdominal placed mesh and the shorter-recovery associated with minimally invasive surgery. Few studies have compared laparoscopy to robotic assisted-laparoscopy in pelvic reconstructive surgery.

Like many techniques in pelvic surgery, trends in the management of pelvic organ prolapse continue to evolve. Unfortunately, such trends are not supported by robust data, specifically that provided by randomized clinical trials. Although robotic technology is new and rapidly spreading throughout the urologic and gynecologic communities, there are no randomized trials comparing outcomes of robotic to more traditional laparoscopic techniques for reconstructive pelvic surgery. Retrospective series indicate comparable efficacy with respect to cure of prolapse. However, to date is it unknown how robotic surgery compares to laparoscopic techniques with respect to cost, patient safety, pain, and ability to return to normal activities.

The use of the robot in laparoscopic surgery is costly. The costs of purchasing a robot has been estimated at $1.5 million dollars with annual maintenance costs of $112,0007. In addition, additional costs exist for the robotic equipment utilized with each case. It is arguable that the maintenance and operative equipment costs may overshadow any potential savings in length of hospital stay and patient convalescence. However, if robotic sacrocolpopexy can provide better immediate quality of life, less pain, and faster recovery compared to laparoscopic techniques, the investment in robotic techniques may very well be cost effective when a societal perspective is taken.

Conditions

Pelvic Organ Prolapse

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Laparoscopic Abdominal Sacrocolpopexy (LASC)

Women assigned to this cohort will receive standard laparoscopic abdominal sacrocolpopexy (LASC)

Group Type: ACTIVE_COMPARATOR

Standard laparoscopic abdominal sacrocolpopexy

Intervention Type: PROCEDURE

Standard laparoscopic abdominal sacrocolpopexy for surgical repair of pelvic organ prolapse.

Robotic Assisted Laparoscopic (RASC)

Women assigned to this cohort will receive robotic assisted laparoscopic abdominal sacrocolpopexy (RASC)

Group Type: EXPERIMENTAL

Robotic assisted laparoscopic abdominal sacrocolpopexy

Intervention Type: PROCEDURE

Robotic assisted laparoscopic abdominal sacrocolpopexy for surgical repair of pelvic organ prolapse.

Interventions

Robotic assisted laparoscopic abdominal sacrocolpopexy

Robotic assisted laparoscopic abdominal sacrocolpopexy for surgical repair of pelvic organ prolapse.

Intervention Type: PROCEDURE

Standard laparoscopic abdominal sacrocolpopexy

Standard laparoscopic abdominal sacrocolpopexy for surgical repair of pelvic organ prolapse.

Intervention Type: PROCEDURE

Other Intervention Names

RASC; LASC

Eligibility Criteria

Inclusion Criteria

1. Stage II to IV pelvic organ prolapse

2. Prolapse of the vaginal apex or cervix to at least half way into the vaginal canal

3. Vaginal bulge symptoms

4. Minimally invasive surgery is planned

5. Available for 12 months of follow-up

6. Able to complete study assessments

7. Able and willing to provide written informed consent

Exclusion Criteria

1. Contraindication to laparoscopic or robotically assisted laparoscopic abdominal sacrocolpopexy

2. Subject wishes to retain her uterus (i.e., surgical assignment may involve removal of uterus, if not previously removed)

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

National Institute for Biomedical Imaging and Bioengineering (NIBIB)

NIH

Sponsor Role: collaborator

Loyola University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Kimberly Kenton, M.D.

Role: PRINCIPAL_INVESTIGATOR

Loyola University

Locations

UCLA

Los Angeles, California, United States

Loyola University Medical Center

Maywood, Illinois, United States

Countries

United States

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Other Identifiers

RC1EB010649-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

201805

Identifier Type: -

Identifier Source: org_study_id