The Effect of Concomitant Hysterectomy Route on Robotic Sacrocolpopexy Outcomes

Sacrocolpopexy is essential in the surgical management of advanced pelvic organ prolapse, and selecting the appropriate route for concomitant hysterectomy is critical.

The aim of this study was to evaluate the effect of the hysterectomy route at the time of robot-assisted laparoscopic sacrocolpopexy (RA-SCP) on mesh exposure. Secondary outcomes were perioperative complications and prolapse recurrence.

This was a retrospective cohort study of 405 patients who underwent an RA-SCP at our institution from January 2013 to July 2019 with at least 6 month follow-up; the patients were grouped with respect to hysterectomy route as robot-assisted supracervical hysterectomy (SCH), total vaginal hysterectomy (VH), and posthysterectomy (PH). The primary outcome measure was mesh exposure. Short-term complications and anatomic failure were also analyzed.

Two hundred three of our patients (50.1%) had a concomitant SCH, 93 (23.0%) had a concomitant VH, and 109 (26.9%) were PH at the time of their robotic sacrocolpopexy. Sacrocolpopexy mesh exposure occurred in 4 patients (1%), with an additional 6 patients (1.5%) with midurethral sling mesh exposure. Mesh exposure rates did not differ significantly between groups. At 6 months after surgery, anatomic failure rates did not differ significantly between groups ( P  = 0.69).Intraoperative and postoperative complication rates were low (bowel obstruction, 2.0%; bladder injury, 1.2%, after excluding those caused by sling trocars; venous thromboembolism, 0.7%; transfusion, 0.5%). Postoperative infection and readmission rates did not differ significantly between groups.

Patients with different routes of hysterectomy at the time of RA-SCP have similar mesh exposure and prolapse recurrence rates. Serious complications are rare in all groups.