This study compares perioperative and functional outcomes between laparoscopic and robotic approaches for combined sacrocolpopexy with ventral rectopexy in patients with multicompartment pelvic organ prolapse and Obstructed Defecation Syndrome. While robotic surgery offers enhanced visualization and dexterity, comparative data using rigorous methodology remain limited. We hypothesized that the robotic approach would demonstrate comparable safety and efficacy while potentially offering advantages in specific perioperative parameters.

A retrospective analysis was conducted on a prospectively collected database from a single institution. We included 97 female patients (71 laparoscopic, 26 robotic) with multicompartment prolapse (POP-Q stage ≥II). Significant baseline imbalances in BMI and parity necessitated propensity score matching (PSM). One-to-one nearest neighbor matching achieved an optimally balanced cohort of 40 patients (all SMD <0.01). Outcomes included operative time, blood loss, complications (Clavien-Dindo), and anatomical success (POP-Q ≤I at 12 months). Secondary endpoints focused on functional symptom resolution, particularly bowel and bladder dysfunction.

intraoperative blood loss compared to the laparoscopic approach (37.5 vs. 50.0 mL, p=0.006), representing a 25% reduction. Operative times (163 vs. 177.5 minutes, p=0.104) and median hospital stay (2.5 vs. 3.0 days, p=0.564) were comparable between groups. Both techniques exhibited a 0% complication rate, with no mesh-related issues or conversions to open surgery. Anatomical success was excellent: 97.5% of the overall matched cohort achieved stage 0-I restoration. Specifically, apical stage 0-I distribution improved from 7.7% preoperatively to 74.3% postoperatively (p<0.001). Posterior compartment restoration was achieved in 88.9% of cases (p<0.001). Functional outcomes showed substantial improvement across all domains. Pelvic pressure resolved in 97.0% of patients, while incomplete bladder emptying achieved 100% resolution. Notably, bowel function improved significantly: constipation resolved in 65.5% of affected cases (p=0.002) and incomplete rectal emptying in 91.7% (p<0.001). Postoperative posterior anatomical correction strongly correlated with the resolution of defecatory symptoms (r=0.71, p<0.001), validating the dual-mesh approach for multicompartment defects. Subjective success rates remained high (95-100%) in both groups.

The study confirms that robotic assistance significantly reduces intraoperative blood loss, likely due to superior visualization and precision in deep pelvic dissection. Despite the smaller sample size after PSM, the treatment effect remained robust. The strong correlation between anatomical correction and symptom relief proves that the combined approach effectively restores both structure and function, particularly through nerve-sparing techniques and lateral ligament preservation.

Robotic combined sacrocolpopexy with ventral rectopexy is a safe and effective alternative to laparoscopy for multicompartment prolapse. It offers reduced blood loss while maintaining equivalent operative efficiency, anatomical success, and functional recovery. Both techniques provide excellent clinical results; the choice of approach should be individualized based on surgeon expertise, patient characteristics, and institutional resource availability.