Implementation of a new procedure: Laparoscopic versus robotic sacrocolpopexy

Purpose: The purpose of this study was to compare the implementation process and the learning curves of laparoscopic and robotic-assisted laparoscopic sacrocolpopexy (LSC and RSC, respectively) for vaginal apex prolapse. Methods: A retrospective study of the first 40 LSC and first 40 RSC procedures performed at one medical center. The primary outcomes were intraoperative bleeding, operative time, and hospitalization. Secondary outcomes were surgical complications. The independent t test, paired t test, χ² test, Fisher's exact test and Pearson's correlation were used to analyze the data. We assumed that 34 participants were needed in each group to detect a 50 ml or more difference in estimated blood loss between laparoscopic and robotic surgeries, Main results: Age, preoperative pelvic organ prolapse quantification (POPQ) staging, and concomitant medical disorders did not differ significantly by procedure type. For LSC and RSC, the mean estimated intraoperative blood loss was 206 ± 107 and 48 ± 55 ml, P < 0.0001; mean operative times were 176 (110-380 min) and 186 (105-345 min), P = 0.34; and mean length of hospital stay, 3.8 ± 1 and 2.4 ± 1 days, P < 0.0001, respectively. Adverse events were rare, not severe, and did not differ significantly by procedure type. Conclusions: RSC and LSC are feasible procedures with acceptable complication rates. RSC enables operating more anatomically with less bleeding.