Subjective and Objective Outcomes of Robotic and Vaginal High Uterosacral Ligament Suspension

This study was designed to assess the short-term outcomes in patients undergoing robotic or transvaginal high uterosacral ligament suspension for symptomatic apical prolapse at the time of hysterectomy.

This retrospective study used hospital and office electronic medical records to identify patients with symptomatic stage 2 to 4 prolapse, who had undergone either a robotic or transvaginal high uterosacral ligament suspension from July 2010 to January 2014. The database was searched using procedural codes for uterosacral ligament suspension. Each patient was contacted 1 year postoperatively to answer the pelvic floor distress inventory-20 via telephone, and this was compared to their initial preprocedural baseline questionnaire.

Our primary outcome included the fulfillment of 3 criteria: (1) Prolapse leading edge of 0 or less and apex of ½ total vaginal length or less; (2) the absence of pelvic organ prolapse symptoms as reported on the pelvic floor distress inventory-20 question No. 3; and (3) no prolapse reoperations or pessary use during the study period. Ninety-two percent (24/26) in the robotic group and 85% (36/42) in the vaginal group (P = 0.46) successfully fulfilled these outcome criteria. There was no significant difference in the operative data between the 2 groups. There were no intraoperative complications in either group.

These short-term outcomes are promising and show a high success rate for the uterosacral ligament suspension at the time of a hysterectomy regardless of whether it was performed vaginally or robotically.