Title: Postoperative complications and unanticipated healthcare encounters following mini-
laparotomy vs. laparoscopic/Robotic-assisted sacrocolpopexy: a comparative retrospective
study
Version: 0 Date: 16 Jan 2024
Reviewer:  Phuc Nhon Nguyen
Reviewer's report:
Ref: Short-term outcomes following mini-laparotomy vs. laparoscopic/Robotic-assisted
sacrocolpopexy: a comparative study
Dear authors,
Thank you for your work on women’s health concerning surgical repair in pelvic organ prolapse
at the authors center. The paper is interesting, however, I recommend some suggestions in the
constructive way, and some points needed to be addressed before publication as below:
-Abstract is well structured. Please add unit to BMI in the result of abstract and main text.
-In Introduction, the authors could mention briefly the non-surgical method such as pessary
(Kuncharapu I, Majeroni BA, Johnson DW. Pelvic organ prolapse. Am Fam Physician.
2010;81(9):1111-1117.). Additionally, some evaluation tools in assessment of pelvic organ
prolapse should be mentioned such as POP-Q, ultrasound, i.e.:
+ Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification
System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75-81.
+ Madhu C, Swift S, Moloney-Geany S, Drake MJ. How to use the Pelvic Organ Prolapse
Quantification (POP-Q) system?. Neurourol Urodyn. 2018;37(S6):S39-S43. doi:10.1002/
nau.23740
+ Gao Y, Zhao Z, Yang Y, Zhang M, Wu J, Miao Y. Diagnostic value of pelvic floor
ultrasonography for diagnosis of pelvic organ prolapse: a systematic review. Int Urogynecol J.
2020;31(1):15-33. doi:10.1007/s00192-019-04066-w
-In methods part, please explain how the patients was divided into one of three different surgical
management (according to hospital protocol based on grade of prolapse or the patient’s option).
Since this option may be a bias and influence to the outcomes.
-Inclusion criteria needed to be more clarified. For example: The patient was indicated to surgical
repair. The patient refused to non-surgical method.
-Exclusion should be more detailed. For example: The patient was contraindicated to surgery due
to severe medical diseases, allergy with drugs which administered during anesthetic procedure.
The patient had an abnormal vaginal bleeding or suspected malignancy.
-Method of anesthesia including regional/local/general anesthesia should be added.
- The use of Baden-Walker Halfway scoring system is great, but the authors should explain it. For
example: “There is greater interobserver variability with the Baden-Walker system compared
with the POP-Q” (Pelvic organ prolapse: a urology perspective, Ian Beckley and Neil Harris,
Journal of Clinical Urology, Volume 6, Issue 2).
-Was the Pelvic Floor Distress Inventory (PFDI-20) questionnaire validated with external
validation in US? Please cite it.
-In surgical technique, the number of surgeon and their experience should be described. The use
of antibiotic before and after surgery. The measurement of estimated blood loss during surgery
should be described.
- Some photos in routine practice or illustrated photos relating to surgical methods are  greatly
recommended.
-In result section, regarding Table 1, occupation/career, previous mode of delivery (vaginal
delivery, assisted vaginal birth, cesarean section), episiotomy, frequency of sexual intercourse,
etc.… could be included. Since these factors may influence on the POP and its treatment.
-In Table 2, estimated blood loss was a parametric or non-parametric data since SD value was
nearly equal to mean value.
- Frequency of the recurrence of apical prolapse after total/sub-total hysterectomy, adherent
structures in abdomen should be added in Table 2.
-Visual analog scale, hospital length of stay should be added in Table 3.
- Some abbreviation words in the table needed to be defined under the table. Ex: RMUS
- The difference between mini-lap and laparo/robotic surgery is only surgical time duration. The
mini-lap reduced substantially the surgical time. However, the cosmetic and satisfactory factors
were not mentioned. The cost of surgical methods should be added, especially, regarding robotic
surgery.
-The sample size remains limited, thus the intra-and postoperative complications were not
different between two group. The Kaplan-Meier cox concerning the occurrence of postoperative
outcomes in 30-Day Unanticipated Healthcare Encounters After Prolapse Surgery could be used
in the future study to observe between 2 groups. The authors should include this point in the
future research part.
Regards,
Phuc Nhon Nguyen MD
Tu Du Hospital, Ho Chi Minh City, Vietnam