Robot-assisted surgery for the management of apical prolapse: a bi-centre prospective cohort study

BJOG. 2019 Jul;126(8):1065-1073. doi: 10.1111/1471-0528.15696. Epub 2019 May 2.


Objective: Robot-assisted surgery is a recognised treatment for pelvic-organ prolapse. Many of the surgical subgroup outcomes for apical prolapse are reported together, leading to a paucity of homogenous data.

Design: Prospective observational cohort study (NCT01598467, assessing outcomes for homogeneous subgroups of robot-assisted apical prolapse surgery.

Setting: Two European tertiary referral hospitals.

Population: Consecutive patients undergoing robot-assisted sacrocolpopexy (RASC) and supracervical hysterectomy with sacrocervicopexy (RSHS).

Methods: Anatomical cure (simplified Pelvic Organ Prolapse Quantification, sPOPQ, stage 1), subjective cure (symptoms of bulge), and quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7).

Main outcome measures: Primary outcome: anatomical and subjective cure.

Secondary outcomes: surgical safety and intraoperative variables.

Results: A total of 305 patients were included (RASC n = 188; RSHS n = 117). Twelve months follow-up was available for 144 (RASC 76.6%) and 109 (RSHS 93.2%) women. Anatomical success of the apical compartment occurred for 91% (RASC) and in 99% (RSHS) of the women. In all compartments, the success percentages were 67 and 65%, respectively. Most recurrences were in the anterior compartment [15.7% RASC (symptomatic 12.1%); 22.9% RSHS (symptomatic 4.8%)]. Symptoms of bulge improved from 97.4 to 17.4% (P < 0.0005). PFIQ-7 scores improved from 76.7 ± 62.3 to 13.5 ± 31.1 (P < 0.0005). The duration of surgery increased significantly for RSHS [183.1 ± 38.2 versus 145.3 ± 29.8 (P < 0.0005)]. Intraoperative complications and conversion rates were low (RASC, 5.3 and 4.3%; RSHS, 0.0 and 0.0%). Four severe postoperative complications occurred after RASC (2.1%) and one occurred after RSHS (1.6%).

Conclusions: This is the largest reported prospective cohort study on robot-assisted apical prolapse surgery. Both procedures are safe, with durable results.

Tweetable abstract: European bi-centre trial concludes that robot-assisted surgery is a viable approach to managing apical prolapse.

Keywords: Pelvic organ prolapse; robot-assisted; sacral colpopexy; sacrocervicopexy; sacrocolpopexy.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Cervix Uteri / surgery
  • Colposcopy / methods*
  • Female
  • Humans
  • Hysterectomy / methods*
  • Middle Aged
  • Pelvic Floor / surgery*
  • Pelvic Organ Prolapse / surgery*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Robotic Surgical Procedures / methods*
  • Sacrum / surgery
  • Tertiary Care Centers
  • Treatment Outcome

Associated data