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Laparoscopic and robotic sacropexy: retrospective review of learning curve experiences and follow-up.

OBJECTIVE
To compare conventional laparoscopic (LSC) and robotic (RSC) sacrocolpopexy in the treatment of apical pelvic prolapse during robotic surgery "learning curve". Operative characteristics, prolapse treatment outcomes, and postoperative results were assessed.


DESIGN
Retrospective comparative study.


SETTING
Department of Obstetrics and Gynecology, University Hospital and Palacky University, Olomouc.


METHODS
We analyzed consecutive 51 patients treated with laparoscopic sacropexy and 13 women operated with robotic system. Data on patient age, body mass index (BMI), operation history, estimated blood loss, operation time, surgical outcomes (including pelvic organ prolapse quantification - POP-Q), and concomitant surgeries were retrospectively obtained from patient medical records. Subjective outcomes were measured through PGI-I and PISQ-IR questionaires when available at last follow up (n = 26).


RESULTS
In both groups all procedures were performed correctly without conversion. The mean operative time was longer in robotic group: 212 (128-394) min, as compared to 164 (80-342) in the laparoscopic group. Blood loss was lower for the robotic 52 (10-200) ml compared to laparoscopic group 58 (10-350) ml. Differences in operative time and blood loss were not statistically significant. Differences between LSC and RSC groups in postoperative results were not statistically significant. Learning curve for robotic sacrocolpopexy was shorter than for laparoscopic procedure in case of experienced laparoscopic surgeons. No recurrences occurred during follow-up. Most patients were satisfied with surgical results.


CONCLUSION
The present study demonstrated that RSC may be comparable in surgical safety and efficacy. The decision regarding the best surgical approach has to be individualised according to the characteristics of the patient and their preferences as well as the local clinical setting and the surgical expertise of physicians.