Perioperative outcomes after robotic versus vaginal surgery for pelvic organ prolapse

The objectives of the study were to compare post-anesthesia care unit opioid use and pain scores, surgical and hospitalization times, and perioperative adverse events rates following robotic sacrocolpopexy (RSC) versus transvaginal uterosacral ligament suspension (USLS). This was a retrospective analysis of women 18 years and older who underwent either robotic sacrocolpopexy (n = 87) or transvaginal uterosacral ligament suspension (n = 103) between January 1, 2015 to December 31, 2017 at Downey Medical Center by two surgeons. Data including nurses' verbal pain scores and opioid use were abstracted from electronic medical records. Adverse events were classified using the Clavien-Dindo scale. Women in the robotic group were older (62 ± 8 years vs 58 ± 11 years, p = 0.005), had higher rate of stage III or IV prolapse [49/87 (56%) vs 15/103 (15%), p < 0.0002], lower postoperative pain scores (2.6 ± 1.8 vs 4.2 ± 2.4, p < 0.0001), and used less opioids (26 ± 17 mg morphine dose equivalent vs 35 ± 24 mg morphine dose equivalent, p = 0.005) than those in the transvaginal group. Readmissions and reoperations for adverse events were not significantly different between the RSC and USLS groups [5/87 (6%) vs 12/103 (12%), p = 0.16], respectively. Moreover, Dindo-Clavien scores of II or higher occurred at similar rates between the two groups [20/87 (23%) vs 26/103 (25%), p = 0.72]. However, patients had a higher rate of prolonged urethral catheterization following USLS (0/87) than RSC (6/103) (p = 0.03). Robotic sacrocolpopexy was associated with less immediate postoperative pain and opioid use compared to uterosacral ligament vaginal suspension.