The suspension of use of sub-urethral mesh in the United Kingdom in 2018 has seen the resurgence of colposuspension in female stress urinary incontinence (SUI) surgery. Open and Laparoscopic Colposuspension techniques are well recognised. Robotic assisted laparoscopic surgery is known to confer advantages of reduced length of stay, blood loss and complications compared to open surgery. We present data from 17 Robotic Colposuspension procedures from a Tertiary Hospital in London, reporting on technique, safety and efficacy.

Approval was obtained from the hospital New and Novel Procedures Committee. The surgical team consisted of 2 functional urologists and 2 robotic uro-oncology surgeons. Since May 2019, 17 cases were performed through a transperitoneal four port technique using the daVinci Si system. Port placement included a supra-umbilical camera port, 2 robotic arms and a 12 mm assistant port, 5cm away from the Left Anterior Superior Iliac Spine, for passage of sutures. The bladder was dropped, the urethrovesical angle was identified along with Cooper's ligament and the vagina. Placement of three tensioned sutures bilaterally suspending paravaginal tissue, towards Cooper’s ligament, incorporating the obturator shelf. A cystoscopy was performed at the end of the procedure to ensure no visible suture in the bladder. Extraperitonealisation of the bladder was performed at the end of the procedure to restore anatomy. (A video of the technique is included). All patients had urodynamic assessment prior to surgery. Data was prospectively gathered including demographic details, pre and post-op pad usage, and urinary incontinence short form questionnaire (ICIQ-UI-SF) scores to assess symptom severity and quality of life. Paired T test analysis for pad usage and ICIQ-UI-SF was conducted.

Since May 2019, 17 cases were performed, with a mean age and BMI of 47(years) and 29(kg/m2) respectively, with a mean follow-up period of 6 months (range 1-10 months). 11 (65%) of patients had pure urodynamic SUI, and 2 (11%) patients had a neuropathic history. 7 (41%) of patients had a previous anti-SUI procedure, where 6 patients had urethral bulking and one Transvaginal Synthetic Tape. Average operating time was 121 mins, blood loss 14mls and length of stay 2 (1-3) days. There were no post-operative complications. One patient had to start temporary de-novo intermittent self-catheterisation three times a week for 4 weeks. There was an 83% improvement in mean pad usage (from 4.8 to 0.8) and a 50% improvement in mean ICIQ-UI-SF scores (from 17 to 8.5). These translated to significant improvements using paired t-testing for pad usage (p=0.001) and ICIQ-UI-SF scores (p=0.0001). On day one post-operatively the mean pain score post operatively on day one was 5/10. One patient had to temporarily perform intermittent self-catheterisation, three times a week for one month, and one patient reported a post operative urinary tract infection.

This report is the largest UK series to date of its kind. Two thirds of this cohort had pure urodynamic SUI, the remainder had mixed urinary incontinence. 41% had previous treatment for SUI. Significant improvements were seen in quality of life scores and number of pads used per day. Robotic Colposuspension is safe and feasible with satisfactory early functional outcomes. It presents a minimally invasive treatment option in female SUI, however needs larger volume evaluation and longer follow-up for further evaluation.

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