• Jacquia F De La Cruz, Erinn M Myers, and Elizabeth J Geller.
• Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina. Electronic address: jfenders@med.unc.edu.
• J Minim Invasive Gynecol. 2014 Nov 1; 21 (6): 1010-4.

Study ObjectiveTo compare the change from pre- to postoperative total vaginal length (TVL) in women who underwent either a total vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery.DesignThis was a retrospective cohort study (Canadian Task Force classification II-2).SettingThis was conducted at 1 tertiary academic medical center over a 2-year period.PatientsWomen who underwent either TVH/USLS or RH/SCP.InterventionsBaseline and postoperative POP-Q Pelvic Organ Prolapse Quantification exams were recorded as well as postoperative validated questionnaires. Twenty-nine subjects were needed in each group to detect a 1.5-cm difference in TVL.Measurements And Main ResultsThere were 38 TVH/USLS and 46 RH/SCP participants. RHs were either total (28/46 [61%]) or supracervical (18/46 [39%]). The mean postoperative follow-up was 9.5 ± 3.1 months. For the primary outcome, women in the TVH/USLS group had a decrease in TVL, whereas women in the RH/SCP group had an increase in TVL (-0.6 ± 1.0 cm vs 0.5 ± 0.8 cm, p < .001). Among sexually active women (55/84, 65.5%), there was no difference in postoperative sexual function between groups based on Pelvic Organ Prolapse/Urinary incontinence Sexual Function Questionnaire short form scores, with good sexual function in both groups (32.6 ± 6.2 TVH/USLS vs 35.1 ± 7.3 RH/SCP, p = .22). Although both groups showed good postoperative apical support, the TVH/USLS group had a slightly lower mean C point compared with the RH/SCP group (-6.8 ± 1.2 vs -7.7 ± 1.8, p = .02). Both groups showed good postoperative pelvic floor function, with no difference in mean postoperative Pelvic Organ Prolapse Distress Inventory scores (42.2 ± 45.4 vs 52.7 ± 46.6, p = .44). Recurrent prolapse (defined as any prolapse at or beyond the hymen) was not different between groups (13.2% for TVH/USLS vs 6.5% for RH/SCP, p = .46).ConclusionVaginal length decreased after vaginal hysterectomy with pelvic support surgery compared with RH with pelvic support surgery, with no differences in postoperative sexual function or pelvic floor function between groups.Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

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