Over the past decade, robotic sacrocolpopexy has gained popularity and is now one of the most common surgical treatment for POP.
However none of the existing data has demonstrated the superiority of robotic sacrocolpopexy over laparoscopic sacrocolpopexy. Of note, all the existing series compared those two approaches performed by highly experienced laparoscopic surgeon. The aim of the present study was to compare the outcomes of robotic vs sacrocolpopexy performed by surgeon in training while in their learning curve.

The charts of all consecutive patients who underwent minimally invasive sacrocolpopexy for POP at a single academic center between 2013 and 2023 were retrospectively reviewed. The patients having undergone laparoscopic or robotic sacrocolpopexy by surgeons in training with an experience < 20 cases of either of the two procedures were included. The patients were divided in two groups: laparoscopic vs robotic.

Laparoscopic N=39
Robotic N=92

Mean operative time (min)

Laparoscopic 229.3 (+/- 64.5)
Robotic 202.6 (+/- 58.1)
P-value 0.02

Post-operative complications

Laparoscopic 8 (22.9%)
Robotic 15 (16.7%)
P-value 0.42

Major post-operative complications (Clavien grade 3 or higher)

Laparoscopic 2 (5.1%)
Robotic 5 (5.4%)
P-value 0.88

Intraoperative vaginal, bladder or bowel injury

Laparoscopic 4 (10.8%)
Robotic 8 (9.2%)
P-value 0.78

Median length of hospital stay (days, IQR)

Laparoscopic 3 (2-4)
Robotic 2 (2-3)
P-value 0.04

Readmission

Laparoscopic 1 (2.5%)
Robotic 4 (4.4%)
P-value 0.99

Out of 197 minimally invasive hysterectomy, 131 were included in the present analysis: 39 in the laparoscopic group and 92 in the robotic group. The patients characteristics were similar in both groups although there tended to be more patients with an history of previous POP repair in the robotic group (17.4% vs. 5.3%; p=0.09) (see table 1). The mean operative time was significantly shorter in the robotic group (202.6 vs. 229.3 min; p=0.02). The postoperative complications rates were comparable in the two groups (22.9% vs. 16.7% ; p=0.42). The length of stay was significantly shorter in the robotic group (median: 2 vs 3 days;p=0.04). After a median follow-up of 12 months, the anatomical success rates were similar in the laparoscopic and robotic groups (90.9% vs. 80.6%; p=0.37) and so were the subjective success rates (100% vs. 95.8%; p=0.25). There was no mesh related complications in any of the two groups.

The robotic approach may outperform the laparoscopic approach in terms of perioperative outcomes for sacrocolpopexy during the learning curve. However, we did not observe significant differences between the two approaches in terms of anatomical and subjective success rates.