Evaluating the morbidity and long-term efficacy of laparoscopic sacrocolpopexy with and without robotic assistance for pelvic organ prolapse

No Difference in Prolapse Recurrence Rates Between Laparoscopic and Robotic-Assisted Sacrocolpopexy: A Long-Term Comparison

OBJECTIVE

To compare the long-term efficacy of conventional laparoscopic sacrocolpopexy with those of robot-assisted laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.

DESIGN

Retrospective cohort study.

SETTING

Tertiary referral center in China.

PATIENTS

A total of 139 patients -74 having laparoscopic and 65 robotic-assisted sacrocolpopexy between January 2015 and December 2021 were included.

INTERVENTIONS

Either laparoscopic or robotic-assisted sacrocolpopexy.

MEASUREMENTS AND MAIN RESULTS

The median follow-up times of the laparoscopic group and robotic-assisted group were 60 (interquartile range 39-91) and 46 (interquartile range 38-73) months, respectively. Compared with laparoscopy, the robotic-assisted group had a shorter operative time (164 ± 37 minutes vs 186 ± 36 minutes; p = .001) with no clinically meaningful blood loss between the groups (76 ± 32.1 mL vs 87.6 ± 33 mL). Mesh exposure occurred in 3 patients (4.1%) in the laparoscopic and 2 patients (3.1%) in the robotic-assisted group. The composite success rate did not significantly differ between laparoscopic and robotic-assisted groups (89.2% vs 90.8%, p = .757). Kaplan-Meier survival analysis also revealed no significant differences in the overall rates of recurrent pelvic organ prolapse between the two groups (p = .915).

CONCLUSION

There is no difference in the rates of prolapse recurrence or mesh exposure at nearly 4 years between laparoscopic or robotic-assisted sacrocolpopexy. There was an average 20-minute time saving for robotic-assisted procedures, with no clinically important difference in blood loss between the surgical approaches.

Robotic sacrocolpopexy: a game worth playing? A critical literature analysis

Robotic sacrocolpopexy is an advanced minimally invasive technique for the surgical management of urogenital prolapse. It offers superior precision, reduced blood loss, and lower conversion rates compared to traditional approaches. However, longer operative times, higher costs, and the need for specialized training remain the most significant challenges of robotic surgery. The advantages of robotic sacrocolpopexy are reduced intraoperative complications, lower blood loss, and decreased conversion rates compared to traditional approaches. However, it was described to involve longer operative times, increased costs, and the need for a specialized training. Additionally, the technique shows significant potential for reducing complications in obese patients and improving cosmetic outcomes. Comparative studies highlight that robotic and laparoscopic sacrocolpopexy yield similar long-term outcomes, with differences primarily in operative time and cost-efficiency robotics. The lack of standardized protocols remains a limitation, and long-term data on durability and cost-benefit analyses are needed. Future research should prioritize optimizing outcomes, reducing costs, and improving accessibility to robotic urogynecologic surgery.

Very long-term outcomes of robotic mesh sacrocolpopexy for pelvic organ prolapse repair

To assess the very long-term functional outcomes and complications of robot-assisted sacrocolpopexy (RASC) at our institution where this robotic technology for pelvic organ prolapse (POP) repair has been available since 2006. A retrospective review of a cohort of women who underwent a RASC was performed by an investigator not involved in the clinical care of these patients. Women with no electronic medical record follow-up in the last 2 years were contacted by telephone. The primary outcome was RASC success defined as (1) no self-report of vaginal bulge, (2) no prolapse beyond the hymen (POP-Q > 0), and (3) no retreatment for prolapse (surgery, pessary). Postoperative symptomatic urinary incontinence (UI), anorectal dysfunction, dyspareunia and any late complication were secondary outcomes. Of 100 women who underwent RASC between 2007 and 2018, 79 patients with a median age of 66 years (IQR 58-71) were included. Median follow-up was 69 months (28-117), with a last visit more than 5 years postoperatively in 48 patients and more than 10 years in 19 patients. A total of 59 patients (75%) met the definition of success. A bothersome vaginal bulge was reported in 18 patients (23%), prolapse beyond the hymen was observed in 12 patients (16%), and further surgery for POP was performed in 9 patients (12%). Twenty-three patients reported postoperative UI (32%) and 21 reported postoperative anorectal dysfunction (39%). RASC provided good long-term results with an unpredictable risk of recurrence independent of the timeline.

Long-term follow-up after laparoscopic reparation of pelvic organ prolapses in a large teaching gynecological center

OBJECTIVE

To provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence.

STUDY DESIGN

We retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I-IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression.

RESULTS

We included 418 patients. Most patients (97.6%) had at least one vaginal delivery and 92 (22%) had a previous prolapse surgery. In 29.74% of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38%) cases, a sacrohysteropexy in 13 (3.11%), and a sacrocolpopexy in 69 (16.5%). Also, concomitantly, 66 (15.79%) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51%) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57%. Only 4.06% of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor.

CONCLUSION

Our series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.

Sacrocolpopexy: The Way I Do It

INTRODUCTION AND HYPOTHESIS

Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP.

METHODS

This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications.

RESULTS

Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele.

CONCLUSIONS

Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

Postoperative complications and unanticipated healthcare encounters following mini-laparotomy vs. laparoscopic/robotic-assisted sacrocolpopexy: a comparative retrospective study

BACKGROUND

Pelvic organ prolapse is a debilitating condition impacting lives of millions of women worldwide. Sacrocolpopexy (SCP) is considered an effective and durable surgical technique for treatment of apical prolapse. The aim of this study was to compare short-term outcomes including postoperative complications and unanticipated healthcare encounters between patients who underwent SCP with a mini-laparotomy approach compared to patients treated with laparoscopic and robotic-assisted laparoscopic SCP.

METHODS

This was a retrospective cohort study including patients treated for apical prolapse at a university affiliated urogynecology practice. Patients over the age of 18 who underwent abdominal SCP between 2019 and 2023 were included. The cohort was formed into two groups: (1) Patients who underwent SCP through a mini-laparotomy incision (Mini-lap group); (2) Patients who underwent laparoscopic or robotic-assisted laparoscopic SCP (Lap/Robot group).

RESULTS

A total of 116 patients were included in the final analysis. Ninety patients underwent either laparoscopic or robotic-assisted SCP, whereas 26 patients underwent SCP with a mini-laparotomy approach. Study participants exhibited a mean age of 63.1 ± 10.3 years, mean body mass index (BMI) of 25.8 ± 4.9 Kg/m2, and 77.6% of them identified as Caucasian. Upon comparison of demographic and past medical history between groups there were no statistically significant differences in age, BMI, menopausal status, race, parity or comorbid conditions. Patients in the Mini-lap group were less likely to have undergone previous abdominal surgery (11.5% vs. 50.6%, p < 0.001) and had more severe apical prolapse (stage 4 prolapse, 40% vs. 21.2%, p < 0.001) than their counterparts in the Lap/robot group. Regarding intraoperative parameters, length of surgery was significantly shorter in the Mini-lap group compared to the Lap/robot group (97.3 ± 35.0 min vs. 242.0 ± 52.6 min, p < 0.001). When focusing on the primary outcome, postoperative complications within the first 30 days after surgery, there were no differences noted between groups. Additionally, the number of unanticipated healthcare encounters, such as phone calls, clinic visits, emergency department visits, urgent care visits, readmissions and reoperations were similar between groups.

CONCLUSIONS

Mini-laparotomy approach for SCP is safe with comparable intra- and postoperative complications, and unanticipated healthcare encounters compared to conventional minimally invasive methods.

Outcomes of robotic and laparoscopic surgery for benign gynaecological disease: a systematic review

Benign gynaecological diseases are usually treated with minimally invasive approaches. Robotic surgery seems an alternative to laparoscopic surgery. No definitive conclusions have yet been made regarding comparison of robotic versus laparoscopic surgery for benign diseases. In this scenario, we performed a systematic review in order to assess the advantages and disadvantages of laparoscopy versus robotic surgery and conclude whether laparoscopy should be replaced by robotic surgery for the treatment of benign gynaecological conditions, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement. We included 64 studies: no significant difference was observed regarding overall complication rate; no significant benefit of robotic approach was demonstrated regarding length of hospital stay and conversion to laparotomy; furthermore, robotic surgery is more easily used by non-experienced surgeons, while it is more expensive and characterised by longer operative time. In conclusion, current evidence indicates neither statistically significant nor clinically meaningful differences in surgical outcomes between robotic and laparoscopic surgeries for benign gynaecological diseases. Impact statementWhat is already known on this subject? Benign gynaecological diseases are usually treated with minimally invasive approaches. Nevertheless, no definitive conclusions have yet been made regarding comparison of robotic versus laparoscopic surgery for benign diseases.What do the results of this study add? No significant difference was observed regarding overall complication rate; no significant benefit of robotic approach was demonstrated regarding length of hospital stay and conversion to laparotomy; furthermore, robotic surgery is more easily used by non-experienced surgeon, while it is more expensive and characterised by longer operative time.What are the implications of these findings for clinical practice and/or further research? Robotic surgery should not replace laparoscopy for the treatment of benign gynaecological conditions; in addition, gynaecologic surgeon should offer robotic surgery for benign diseases only after a proper counselling and a balanced decision-making process involving the patient.

New "Wrinkle Method" for Intracorporeal Anterior Vaginal Wall Plication during Sacrocolpopexy

In this study, we introduce a new wrinkle method for intracorporeal anterior vaginal wall plication during sacrocolpopexy for pelvic organ prolapse (POP) aiming to decrease POP recurrence and postoperative vaginal wall mesh erosion. The wrinkle method was performed using robotic sacrocolpopexy (RSC) on 57 symptomatic POP patients. Sixty-six patients underwent conventional RSC before the development of the wrinkle method. Feasibility and perioperative outcomes were compared. The wrinkle method is not time consuming. The total operative time was shorter in the wrinkle group than in the non-wrinkle group; however, this was attributed to lower adhesiolysis in the wrinkle group. No differences were recorded in the mean estimated blood loss and complication rates between the two groups. In conclusion, although we were unable to confirm that the wrinkle method decreased POP recurrence and vaginal wall mesh erosion after RSC because of the short follow-up period, our preliminary findings are positive in terms of safety. Further long-term well designed randomized controlled trials are required to elucidate the benefits of the wrinkle method.