Robotic vs Laparoscopic Sacrocolpopexy During the Early Training Phase: A Single Center Study

Pelvic organ prolapse (POP) affects up to two-thirds of parous women. Surgical repair is commonly offered to patients with symptomatic POP. Sacrocolpopexy is considered the reference surgical approach for most patients. While laparoscopy has long been the standard, robotic assistance has gained popularity, particularly for its potential educational advantages. However, comparative studies have largely involved highly experienced surgeons, limiting conclusions regarding outcomes during the learning curve. This study aimed to compare robotic and laparoscopic sacrocolpopexy performed by surgeons in training.

We conducted a retrospective single-center study including all consecutive patients who underwent minimally invasive sacrocolpopexy between 2011 and 2023 by surgeons with fewer than 20 prior procedures. Patients were divided into laparoscopic and robotic groups. The co-primary endpoints were anatomical success (Baden-Walker grade 0) and subjective success (PGI-I score 1-2) at 3 months and last follow-up.

One hundred thirty-one patients were included (39 laparoscopic, 92 robotic), with comparable baseline characteristics. At a median follow-up of 12 months, anatomical success rates were similar between groups (92.3% vs 84.8%; p = 0.39), as were subjective success rates (100% vs 94.4%; p = 0.65). The robotic approach was associated with a significantly shorter operative time (202.6 vs 229.3 min; p = 0.02) and shorter hospital stay (2 vs 3 days; p = 0.04). Rates of intraoperative complications (10.2% vs 9.7%; p = 0.78) and postoperative complications (22.9% vs 16.7%; p = 0.42) were similar. No mesh-related complications were observed.

In this retrospective cohort, robotic sacrocolpopexy performed during the early training phase was associated with shorter operative time, while achieving similar short-term anatomical and functional outcomes. Further studies are warranted to confirm these findings.