The Safety of Robot-Assisted Sacrocolpopexy in Pelvic Organ Prolapse Treatment: Systematic Review and Meta-Analysis

The aim of this study is to evaluate the safety of robot-assisted sacrocolpopexy (RSP) compared with other approaches of sacrocolpopexy and vaginal surgery in pelvic organ prolapse (POP).

The search was performed on studies published prior to May 2024. The inclusion criteria were randomized and nonrandomized trials involving adult women with POP. Exclusion criteria comprised other forms of intervention treatments and articles lacking comparative analyses. This study adhered to the Population, Intervention, Comparison, and Outcome framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist, and was registered in the Prospective Register of Systematic Reviews.

The systematic review included 36 studies, whereas the meta-analysis included 30 studies. RSP demonstrated superior outcomes compared with laparoscopic (LSP), abdominal (ASP), and vaginal surgery (VS) approaches, with fewer perioperative complications (p < 0.00001 for RSP vs ASP; p = 0.01 for RSP vs VS), reduced blood loss (total p < 0.00001 for RSP vs LSP, ASP, and VS), and shorter hospital stays (p = 0.003 for RSP vs LSP; p = 0.27 for RSP vs VS). Additionally, RSP had fewer surgical conversions than LSP (p = 0.01). However, LSP and VS showed significantly shorter operation times than RSP (p < 0.00001).

Robot-assisted sacrocolpopexy may offer advantages in reducing blood loss compared with VS and shortening hospital stays compared with LSP. Sensitivity analyses, however, revealed no significant differences in perioperative complications or blood loss compared with LSP and ASP. Further high-quality randomized studies are necessary to confirm the safety and efficacy of RSP.