Robot-assisted sacrocolpopexy (RASC) is a minimally invasive alternative for pelvic organ prolapse (POP) correction. Although this procedure offers potential enhanced precision and ergonomics, uncertainty surrounding its learning curve impacts its adoption and outcomes. We aim to investigate the learning curve of RASC, exploring the operating times, complication rates and patient-reported outcomes (PROs) results of a single laparoscopic experienced surgeon in a tertiary center.

This retrospective cohort analysis was performed at a single tertiary service, incluiding all patients who underwent RASC by a single senior surgeon who had no prior RASC experience, with a 12-month follow-up. Primary objectives included surgical success (POP-Q system), operating time, intraoperative and postoperative complication rates (Clavien-Dindo ≥ II), mesh-related complications and surgical reintervention for prolapse. Subjective surgical success was measured using the validated short form of the Pelvic Floor Impact Questionnaire (PFIQ-7). Study received ethics committee waiving.

Twenty-three consecutive patients underwent RASC. The surgical success rate at 12 months was 100%. The average surgical time was 198 minutes, with a mean blood loss of 57,8mL. The average length of hospital stay was 1,17 days. Intraoperative complication rate was 8.68% (1 bladder injury and 1 vaginal injury). There were no bowel injuries, mesh-related complications or re-interventions. The average PFIQ-7 summary score after 12 months was 36,27. CUSUM analysis revealed a significant decrease in surgical time after the fourth case (with some outliers around 17th to 19th cases, normalizing thereafter) (figure 1).

The achievement of 100% objective success shows no learning curve's influence on this important outcome.The learning curve did not impact blood loss or length of stay, as this results are comparable to other studies.  The observed decrease in operating time following initial cases is consistent with a easy and rapid transition from laparoscopic to robotic approach. There were no major complications or reinterventions within the first year, providing reassurance about the procedure's short-term safety profile throughout this learning period. The considerable improvements observed by patients across all PFIQ-7 areas demonstrate the surgical efficacy of RASC, translating into concrete advantages in patient quality of life.

RASC learning curve did not impact RASC surgical outcomes and patient reported outcomes. The decrease in operative times following first four cases suggests a quick transition from laparoscopic to robotic approach. The lack of major complications or reinterventions within the first year is reassuring. PFIQ-7 scores reflect the surgical effectiveness of RASC, resulting in improved patient quality of life.

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