Minimally invasive surgery in urogynecology: a comparison of standard laparoscopic, minilaparoscopic, percutaneous surgical system and Robotic sacral colpopexy

BACKGROUND: We compared surgical outcome of sacral colpopexy (SCP) performed with the most recent minimally invasive surgery such as 3 mm laparoscopy (MiniLPS), percutaneous system (PSS), standard laparoscopy (LPS) and robotic.

METHODS: This is a multicenter retrospective cohort study conducted at Urogynecological department of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome and at the Gynecological Clinic of the Hospital Maggiore della Carità of Novara and of Policlinico di Abano. We collected data of 115 patients who underwent laparoscopic SCP for pelvic organ prolapse between June 2017 and June 2018 using PSS, MiniLPS, standard LPS and da Vinci Si.

RESULTS: Patients of all four groups had similar characteristics. The median Operative time (OT) was significantly longer in Robotic procedure compared to all other groups There were no significant differences between the 4 groups in terms of estimated blood loss, conversion to laparotomy, intraoperative complications and median postoperative ileus. Visual analogue scale (VAS) at 4 h was significantly less for miniLPS compared to the other techniques. VAS at 24 h was higher for Robotic procedures than other techniques.

CONCLUSIONS: Results rule out that minimize surgical invasiveness of laparoscopic techniques could bring improvements in SCP not only from a cosmetic point of view but also from a functional one without requiring longer OT and maintaining the same standard laparoscopic configuration. Even if Robotic SCP is useful and safe because of its guarantee of efficiency, it cannot be considered the first choice for many women.