Robot-assisted, laparoscopic and abdominal sacrocolpopexy for high-stage pelvic organ prolapse: a retrospective, multi-centre study

Abstract

OBJECTIVE: To explore the efficacy of robotic-assisted, laparoscopic and abdominal sacrocolpopexy in treating high-stage pelvic organ prolapse.METHODS: A retrospective multi-centre study was performed. From January 2013 to December 2020, female patients who underwent abdominal sacrocolpopexy (ASC), laparoscopic abdominal sacrocolpopexy (LASC) or robot-assisted abdominal sacrocolpopexy (RASC) in three medical centres of Chinese PLA General Hospital were included. Clinical data were collected, and all patients were followed up for more than 12 months. Anatomic POP-Q were recorded to evaluate the pelvic floor level. In addition, pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionaire-7 (PFIQ-7) and Patient Global Impression of Improvement (PGI-I) were used to evaluate the life quality after surgery.RESULTS: Sixty-nine cases were enrolled in this study, including 35 undergoing ASC, 10 undergoing LASC and 24 undergoing RASC. Patients in ASC (56.3±7.2) were younger than those in LASC (62.2±8.0) and RASC (64.3±10.4). During surgery, the blood loss in ASC (244.9±216.6 ml) was significantly more than in LASC (126.3 ± 84.6 ml) and RASC (62.9 ± 77.5 ml). And RASC (149.0±43.6 min) had a significant advantage in operating time over ASC (188.9 ± 55.8 ml) and LASC (185.5 ± 44.4 ml). There was no intraoperative complication in three groups. In the POP-Q follow-up, postoperative Aa, Ba, Ap, Bp in all groups were significantly improved than the baseline (P<0.05). The objective and subjective cure rates were all 100%. PGI-I score was satisfying (1-2). Postoperative PFDI-20 and PFIQ-7 decreased dramatically after surgery in three groups (P<0.05). Mesh exposure occurred in 10 cases (5 in ASC, 1 in LASC, 4 in RASC, P>0.05) at 2-12 months and were less than 1cm in 8 cases (2A/T3/S1), 1-2cm in 2 cases (3B/T3/S1). The mesh exposures healed after estrogen local application without readmission for surgery.CONCLUSION: RASC showed some advantages over LASC and ASC. It can be recommended in sacrocolpopexy with or without hysterectomy.