To compare surgical and patient-reported outcomes between Robot-assisted sacrocolpopexy (RASC) and laparoscopic sacrocolpopexy (LSC) with anterior and posterior mesh placement for pelvic organ prolapse (POP) correction, over a 12-month follow-up period.

A retrospective cohort study was conducted at a single tertiary referral center, including consecutive patients who underwent RASC or LSC with anterior and posterior mesh placement by the same senior experienced surgeon or supervised by him. Primary endpoints included objective surgical success, defined by the Pelvic Organ Prolapse Quantification (POP-Q) system and subjective success, assessed through validated patient-reported outcomes measures such as the PFIQ-7 questionnaire and Wexner score for constipation. Secondary outcomes included perioperative parameters (operative time, blood loss, length of stay), complication rates (Clavien-Dindo classification superior or equal to 2), mesh-related complications and the need for reintervention. Study received ethics committee waiving.

A total of 44 patients were included, with 23 undergoing RASC and 21 undergoing LSC from January 2023 to March 2024. At 12 months, objective surgical success was achieved in 100% of RASC cases and 85,7% of LSC cases, according to the POP-Q system.. LSC was associated with shorter operative times (198 minutes vs. 221 minutes, p=0,19), shorter length of stay (1,17 days vs. 2,33 days, p=0,001) and similar estimated blood loss (57,3mL vs. 58,2mL, p=0,754). 
The complication rate was similar in both groups (RASC vs. LSC): bladder injury 4,34% (1/23) vs 9,52% (2/21), vaginal injury 4,34% (1/23) vs 0% (0/21). There were no bowel injuries or mesh-related complications in both techniques. The overall reoperation rate was 0% vs. 14,3%, p=0,06.
By the application of the PFIQ-7, RASC patients scored 117,4 vs. 131,7 LSC patients. In a PFIQ-7 section analysis, there was found a significant difference in CRAIQ-7 (Colorectal-Anal Impact Questionnaire section): RASC 38,4 vs. LSCP 52,9, p<0,001. In the remaining sections - Pelvic Organ Prolapse Impact Questionnaire (POPIQ) and Urinary Impact Questionnaire (UIQ-7) there was no statistically significant difference. Age and BMI did not impact the PFIQ-7 summary score.

This study comparing RASC and LSC for POP repair with mesh reveals that both techniques achieve high objective success at 18 months, with a trend towards superiority for RASC. 
First, in the 12-month span of the study, RASC achieved higher success rates. While operative times and blood loss were not statistically different, RASC significantly reduced the length of hospital stay, which translates directly to faster patient recovery, reduced hospital resource utilization and potentially compensating robotic platform associated costs. This quicker return to home can also significantly improve patient satisfaction and well-being in the immediate postoperative period. Furthermore, the significant reduction in CRAIQ-7 scores favoring RASC suggests a tangible clinical benefit in terms of bowel function. While the exact mechanism requires further investigation, we can propose that the enhanced precision and potentially less tissue manipulation afforded by the robotic platform during promontory fixation and posterior mesh placement may contribute to these benefits.

In summary, while both techniques demonstrate high surgical success, RASC offers a clinically meaningful benefit through accelerated postoperative recovery and improved colorectal-anal function, while being a safe and effective option for POP correction. These findings warrant consideration when selecting the surgical approach for sacrocolpopexy with mesh placement. Larger prospective studies are needed to further explore these advantages and their long-term impact.

Gilleran JP, Johnson M, Hundley A. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010 Oct;2(5-06):195-208. doi: 10.1177/1756287210379120. PMID: 21789075; PMCID: PMC3126084.
Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, Brubaker L, Bresee C, Kenton K. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstet Gynecol. 2014 Jan;123(1):5-12. doi: 10.1097/AOG.0000000000000006. Erratum in: Obstet Gynecol. 2014 Jul;124(1):165. PMID: 24463657; PMCID: PMC4266590.