Robotic Uterosacral Ligament Suspension Versus Robotic Sacrocolpopexy for Uterovaginal Prolapse

Objectives: The aim of this study was to compare the short-term surgical success of robotic uterosacral ligament suspensions (RUSLS) to robotic sacrocolpopexy (RSCP) in women with uterovaginal prolapse.

Methods: We conducted an institutional review board-exempt retrospective cohort study. This study reviewed hospital and office-based electronic medical records (EMR) to identify patients who had either a robotic-assisted total laparoscopic hysterectomy with RUSLS or a robotic-assisted supracervical hysterectomy with RSCP from February 2018 to March 2022. The EMR was searched utilizing procedural codes. Each patient’s chart was screened for inclusion including a pre-operative POP-Q assessment and a repeated prolapse assessment post-operatively. The primary outcome was success, defined as absence of feeling a bulge, no retreatment, and no prolapse beyond the hymen on examination at one year post-operatively. The secondary outcome was peri-operative and post-operative complications. Results were analyzed utilizing parametric and nonparametric testing, as appropriate. For this analysis, p< 0.05 was considered statistically significant.

Results: We evaluated 721 patient charts that had a matched procedural code of robotic USLS, robotic-assisted total laparoscopic hysterectomy, robotic supracervical hysterectomy, and robotic sacrocolpopexy from February 2018 to March 2022. Two-hundred-eighty- seven met the inclusion criteria; 41 patients had a robotic-assisted total laparoscopic hysterectomy with RUSLS and 246 had a robotic-assisted supracervical hysterectomy with RSCP. Baseline characteristics were similar between both groups except the RUSLS group was younger (54 years old vs 60 years old, p=0.001), were more often non-white patients (36.6 % versus 14.6%, p= 0.005), and included more smokers (65.4% versus 35.6%, p=0.003). The total success rate for all participants was 95.8%; 92.7% for the RUSLS group and 96.3% for the RSCP group, p=0.39. The rate of peri-operative and post-operative complications was found not to be significantly different, p=0.34.

Conclusions: These short-term outcomes are promising for offering a robotic-assisted uterosacral ligament suspension as a viable alternative with a high success rate to robotic sacrocolpopexy for the treatment of uterovaginal prolapse.