Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature

Abstract

The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females.Sacrocolpopexy is the "gold standard" repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques.The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients.Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

Advanced Cystocele is a Risk Factor for Surgical Failure after Robotic-assisted Laparoscopic Sacrocolpopexy

“…The authors report 95.7% objective POP cure and a mesh erosion rate of only 2.1%. Despite such encouraging results, we believe such an approach should be considered with caution, in light of the literature indicating a higher risk for mesh erosion in the presence of total versus supracervical hysterectomy and the combination of vaginal mesh attachment [25,26].…”

Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

“…Robots are expensive tools that facilitate the performance of surgical maneuvers through better vision and more effective instruments. These technologically advanced platforms ease the execution of minimally invasive procedures by less-experienced surgeons or make the performance of a technically challenging procedure more effective in the hands of an expert laparoscopic surgeon, thus extending the indications of minimally invasive surgery beyond the boundaries set by the limitations of standard laparoscopic instruments [ 3 ].…”

Robotic-assisted Gynecological Surgery in Older Patients – a Comparative Cohort Study of Perioperative Outcomes

“…The use of robotic-assisted surgical systems, which represents a technological advance in minimally invasive surgery, is becoming increasingly popular among gynecological surgeons in Europe 1 . While robotic assistance is already widely used in gynecological-oncological surgery 2 3 , it is now increasingly being used in the surgical treatment of complex benign gynecological diseases, for procedures requiring extensive suturing 4 , in obese female patients, or in patients who have had multiple previous abdominal operations 5 6 . The use of high-precision instruments, excellent imaging of the anatomy, and good ergonomics mean that the risk of minimally invasive approaches requiring conversion in cases with advanced disease is decreasing and this approach can even be used in cases with complex constraints.…”

“…Der Einsatz eines roboterassistierten Operationssystems als technologische Weiterentwicklung in der minimalinvasiven Chirurgie erreicht zunehmende Popularität unter den operativen Gynäkologen Europas 1 . Während robotische Assistenz in der gynäkoonkologischen Chirurgie bereits verbreitet ist 2 3 , findet sie Einzug in die operative Behandlung komplexer benigner gynäkologischer Entitäten, bei nahtintensiven Prozeduren 4 , bei adipösen Patientinnen oder nach multiplen abdominalen Voroperationen 5 6 . Durch Hochpräzisionsinstrumente, exzellente Darstellung der Anatomie und entlastende Ergonomie wird der minimalinvasive Zugang mit abnehmendem Risiko für eine Konversion auch bei fortgeschrittener Erkrankung und unter komplexen Randbedingungen nutzbar.…”