Minimally Invasive Sacrocolpopexy (Laparoscopic and Robotic): Its Outcomes and Complications—Our Experience

Abstract

Introduction:The gold standard treatment for managing patients with pelvic organ prolapse (POP) is sacrocolpopexy. Initially, open sacrocolpopexy was adopted; however, over the years classic laparoscopic approach and its modifications in the form of single port laparoscopy, NOTES (vaginal-assisted laparoscopy) and robotic-assisted laparoscopic sacrocolpopexy (LSC) have emerged. Usage of minimally invasive approaches has gained momentum in the recent past as they reduce the morbidity associated with open sacrocolpopexy, allowing faster recovery of the patient. Classic LSC has similar outcomes to abdominal sacrocolpopexy but is technically challenging especially due to the pelvic organ surgery offering limited area available for operating. Overcoming these limitations, by the characteristic features of the robotic system such as a "simulated wrist" of the mechanical arm with its enhanced freedom of movement along with a three-dimensional field of view, has attracted significant interest in recent years for robotic sacrocolpopexy (RSC). Aims: To evaluate outcomes and complications following minimally invasive sacrocolpopexy in patients with POP. Materials and methods:We evaluated a total of 20 patients with POP, 15 of those underwent LSC and five patients underwent RSC. We assessed outcomes in both these groups in terms of operating times, blood loss, blood transfusion, surgery-related complications, total hospital stay, and recurrence rates at 1-year follow-up. Results: Patients having RSC had a significantly lower rate of blood loss of ≤300 mL. Maximum postoperative complications were recorded as Clavien-Dindo grade I (seen in 75% of the patients). Most common among these were dysuria and urinary infection (seen in 40%). No Clavien-Dindo grade IVa, IVb, and V complications were recorded in either laparoscopic or robotic techniques conducted at our hospital. At 1 year of follow-up, no significant recurrence was seen in RSC (0%), while a low recurrence rate was seen in LSC (two patients, 13%). Conclusion:Robotic technology provides some advantages as compared to classic laparoscopic surgery. However, both approaches appear to provide equivalent clinical outcomes. But the cost of utilizing and maintaining the robotic system appears to be significant. Hence LSC is the suitable method of treating POP, especially in a country like India. However large randomized trials comparing both techniques are warranted.