Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy

Abstract

Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.

Pathological Insights on Polypropylene Mesh Complications From Laparoscopic Sacrocolpopexy: A Case Series

“…Fourth, the vNOTES surgical technique for mesh extraction is evaluated. vNOTES has been reported to have numerous advantages over traditional open surgery, including minimal invasiveness, reduced postoperative pain, and faster recovery [34][35][36][37]. Additionally, it has been shown to be beneficial in patients with a high body mass index [16,17].…”

“…Furthermore, it is anticipated that vNOTES, which allows for the direct visualization of problematic mesh areas through the vagina, will be a more effective approach than laparoscopic mesh removal because of the latter's limited visibility of the affected areas. vNOTES also offers a minimally invasive approach compared to traditional open surgery, reducing the risk of infection and postoperative complications [34][35][36][37]. Moreover, vNOTES, which allows direct visualization and manipulation of the mesh through the vaginal canal, may offer better access to the mesh than abdominal laparoscopic approaches.…”