Open and Laparoscopic Colposuspension are well recognised treatment modalities for female urodynamic
stress urinary incontinence (SUI) since the decline of use of sub-urethral mesh in the United Kingdom, which occurred in 2018. Robotic assisted laparoscopic surgery is reported to reduce complication rates, duration of hospital inpatient stay and blood loss when compared with the open technique. We report on the outcomes of a new service of Robotic-assisted laparoscopic colposuspension at a London Tertiary Hospital, reporting on safety, efficacy, and technique.

A prospective review of all patients was conducted from April 2019 to November 2020 at a
tertiary London hospital. The surgical team consisted of 2 functional urologists and 2 robotic uro-oncology surgeons. All cases were performed through a transperitoneal four port technique using the daVinci Si system. Port placement included a supra-umbilical camera port, 2 robotic arms and a 12 mm assistant port, 5cm away from the Left Anterior Superior Iliac Spine, for passage of sutures. The bladder was dropped, the urethrovesical angle was identified along with Cooper's ligament and the vagina. Placement of three tensioned sutures bilaterally suspending paravaginal tissue, towards Cooper’s ligament, incorporating the obturator shelf. A cystoscopy was performed at the end of the procedure to ensure no visible suture in the bladder. Extraperitonealisation of the bladder was performed at the end of the procedure to restore anatomy. All patients had urodynamic assessment prior to surgery. Prospective data on demographic details, pre-operative and post-operative pad usage, and urinary incontinence short form (ICIQ-UI-SF) and overactive bladder questionnaires (ICIQ-OAB) were gathered to assess symptom severity and impact on quality of life. Information on patient satisfaction was acquired through PG-II scores. Paired T test analysis for pad usage and ICIQ-UI-SF was conducted.

24 patients were identified, with a mean age and BMI of 49 years and 28kg/m2 respectively. The mean
follow-up period was 10 months (range 1-18 months). 16 (66.7%) patients had pure SUI, while 8 (33.3%) patients had mixed urinary incontinence (MUI). 8 (33%) were recurrent SUI after previous SUI treatment. 
8 (33.3%) had previous SUI treatment, out of which 7 had a urethral bulking procedure and 1 had a Transvaginal Synthetic Tape. The average operating time was 126 minutes. The mean 24-hour pad use reduced from 4.9 pre-procedure to 1.3 pads post-procedure whilst mean ICIQ-UI-SF scores improved from 17.6 pre-operatively to 9.6. These were significant changes using paired t-tests for ICIQ-UI-SF scores (p=0.001) and pad usage (p=0.001). There was no significant change in the mean ICIQ-OAB scores from 6.0 pre-procedure to 5.0 post-procedure. The average PGII score was 2.78. The mean length of stay was 2 nights. The mean blood loss was 20.1mls. The mean console time was 126.5 minutes. The lone post-operative complication was a urinary tract infection, which is classified as a Clavien-Dindo 1 complication.

This report is the largest UK series to date of its kind. 66.6% of the patient cohort had pure SUI. 33.3% of patients had previous treatment for SUI. There was significant improvement in pad usage and quality-of-life scores. Robotic Colposuspension is a feasible treatment option for female SUI with promising early functional outcomes. It is a viable minimally invasive option for female SUI and would benefit from a longer term evaluation with a larger volume of patients.