Long-term outcomes of robot-assisted sacrocolpopexy: 11-year experience of the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology

Introduction. Sacrocolpopexy (SCP) is a well-established technique that over the past decades has become the “gold standard” for the correction of apical pelvic organ prolapse (POP) due to its high efficacy. The widespread adoption of robotic surgery allowed to make this labor-intensive intervention more ergonomic.

Aim. To evaluate long-term efficacy of robot-assisted SCP in patients with POP.

Materials and methods. The single-center cohort prospective study included 309 patients with isolated or combined stage III–IV apical POP according to the Pelvic Organ Prolapse Quantification system (POP-Q). All patients underwent robot-assisted POP repair at the V.I. Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology between 2013 and 2024. Subjective outcomes were assessed using the internationally validated questionnaires: Pelvic Organ Prolapse Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12.

Results. Median postoperative follow-up period for patients was 74.6 (44.5–110.2) months. The most common phenotype of recurrent disease was anterior vaginal wall prolapse, accounting for 5.8 % (n = 18) of observations. Recurrence of the sensation of a foreign body in the vagina occurred in 3.9 % (n = 12). Despite this, the reoperation rate was 1.6 % (n = 5). Intraoperative complications occurred in 2.3 % (n = 7) of patients, and there were no cases of conversion. Vaginal erosions were observed in 0.3 % (n = 3) of operated women.

Conclusion. The obtained data reflect the long-term efficacy of robot-assisted SCP, highlighting its viability as a surgical treatment for apical POP. It is most relevant to consider this intervention for patients after previous reconstructive plastic surgery or hysterectomy. The target patients for the robot-assisted approach are women with complex surgical history, severe somatic diseases, and obesity.

1. Arthure H.G., Savage D. Uterine prolapse and prolapse of the vaginal vault treated by sacral hysteropexy. J Obstet Gynaecol Br Emp 1957;64(3):355–60. DOI: 10.1111/j.1471­0528.1957.tb02652

2. Lane F.E. Repair of posthysterectomy vaginal­vault prolapse. Obstet Gynecol 1962;20:72–7. DOI: 10.1097/00006250­196207000­00009

3. Pan K., Zhang Y., Wang Y. et al. A systematic review and metaanalysis of conventional laparoscopic sacrocolpopexy versus robotassisted laparoscopic sacrocolpopexy. Int J Gynaecol Obstet 2016;132(3):284–91. DOI: 10.1016/j.ijgo.2015.08.008

4. Callewaert G., Bosteels J., Housmans S. et al. Laparoscopic versus robotic­assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg 2016;13:115–23. DOI: 10.1007/s10397­016­0930­z

5. Rybnikov S.V., Danilina O.A., Kopyrin I.Yu. et al. Medium­term results of surgical correction of combined pelvic organ prolapse in women of reproductive age. Mat i ditya v Kuzbasse = Mother and Baby in Kuzbass. 2025;(1):45–51. (In Russ.)

6. Berg P.A., Musin I.I., Yаshchuk A.G. et al. Promontofixation using titanium mesh implant in a patient with genital prolapse: a clinical case. Kreativnaya khirurgiya I onkologiya = Creative surgery and oncology 2023;13(4):335–41. (In Russ.). DOI: 10.24060/2076­3093­2023­13­4­335­341

7. White A.B., Carrick K.S., Corton M.M. et al. Optimal location and orientation of suture placement in abdominal sacrocolpopexy. Obstet Gynecol 2009;113(5):1098–103. DOI: 10.1097/AOG.0b013e31819ec4ee

8. Shiozawa T., Huebner M., Hirt B. et al. Nerve­preserving sacrocolpopexy: anatomical study and surgical approach. Eur J Obstet Gynecol Reprod Biol 2010;152(1):103–7. DOI: 10.1016/j.ejogrb.2010.05.009

9. Kiyomatsu T., Ishihara S., Murono K. et al. Anatomy of the middle rectal artery: a review of the historical literature. Surg Today 2017;47(1):14–9. DOI: 10.1007/s00595­016­1359­8

10. Ercoli A., Campagna G., Delmas V. et al. Anatomical insights into sacrocolpopexy for multicompartment pelvic organ prolapse. Neurourol Urodyn 2016;35(7):813–8. DOI: 10.1002/nau.22806

11. Pan K., Cao L., Ryan N.A. et al. Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse. Int Urogynecol J 2016;27(1):93–101. DOI: 10.1007/s00192­015­2775­9

12. Maldonado P.A., Norris K.P., Florian­Rodriguez M.E. et al. Sacrocolpopexy with concomitant total vs supracervical hysterectomy: functional support comparisons in cadavers. Female Pelvic Med Reconstr Surg 2019;25(3):213–7. DOI: 10.1097/SPV.0000000000000532

13. Jeanditgautier E., Mayeur O., Brieu M. et al. Mobility and stress analysis of different surgical simulations during a sacral colpopexy, using a finite element model of the pelvic system. Int Urogynecol J 2016;27(6):951–7. DOI: 10.1007/s00192­015­2917­0

14. Boukerrou M., Orazi G., Nayama M. et al. Technique de la promontofixation: suspension au promontoire par fils ou Tackers? J Gynecol Obstet Biol Reprod (Paris) 2003;32(6):524–8. [Promontofixation procedure: use of non­absorbable sutures or Tackers? J Gynecol Obstet Biol Reprod (Paris) 2003;32(6):524–8. (In French.)].

15. Gadonneix P., Ercoli A., Scambia G., Villet R. The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol 2005;17(4):376–80. DOI: 10.1097/01.gco.0000175355.48802.7b

16. Ismail S., Duckett J., Rizk D. et al. Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J 2016;27(11):1619–32. DOI: 10.1007/s00192­016­3076­7

17. Lee R.K., Mottrie A., Payne C.K., Waltregny D. A review of the current status of laparoscopic and robot­assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol 2014;65(6):1128–37. DOI: 10.1016/j.eururo.2013.12.064

18. Klyushnikov I.D., Popov A.A., Enikeev M.E. et al. Surgical correction of anterior apical genital prolapse from the position of surgical access. Rossiysky vestnil akushera­ginekologa = Russian Bulletin of Obstetrician­Gynecologist 2023;23(3):85–91. DOI: 10.17116/rosakush20232303185

19. Unger C.A., Barber M.D. Vaginal mesh in pelvic reconstructive surgery: controversies, current use, and complications. Clin Obstet Gynecol 2015;58(4):740–53. DOI: 10.1097/GRF.0000000000000148