Robotic abdominal sacrocolpopexy/sacrouteropexy repair of advanced female pelvic organ prolaspe (POP): utilizing POP-quantification-based staging and outcomes

To assess the management of advanced pelvic organ prolapse (POP) with robotic-assisted abdominal sacrocolpopexy (RASC) and evaluate outcomes using the POP quantification scale (POP-Q). Women with symptomatic stages III and IV POP were evaluated at our institution. After complete clinical assessment, including POP-Q-based physical examination and urodynamic studies, the patients underwent RASC with or without anti-incontinence surgery in the presence (sacrouteropexy) or absence of uterus (sacrocolpopexy). Follow-up examinations at 3 and 6 months included a POP-Q-based examination. Fifteen women were consented for RASC; 12 underwent successful RASC, one required conversion to laparoscopic ASC, one to open ASC, and one to transvaginal repair. The mean (range) patient age was 64 (50-79) years. Before surgery, the mean POP-Q stage was 3.1 (3-4) and the POP-Q values for the anterior (Aa, Ba), posterior (Ap, Bp) and apex (C) of the vagina were: Aa - 0.9, Ba + 1.0, Ap - 1.0, Bp + 1.3, and C +2.1. After surgery, the mean POP-Q stage was 0 and the POP-Q values had improved to Aa - 2.29, Ba - 2.29, Ap - 2.65, Bp - 2.65, and C - 8.28. The mean (range) estimated blood loss during surgery was 81 (50-150) mL. The mean hospital stay was 2.4 (1-7) days. Seven patients had concurrent placement of a mid-urethral sling and one patient had a concurrent Burch colposuspension. These early results show that RASC is safe and efficacious, and that its anatomical outcomes compare favourably to the reported results for open or laparoscopic ASC.