After the age of 70, the cumulative incidence of surgery of pelvic organ prolapse (POP) reaches 11%. Over the past deaces robotic sacrocolpopexy has gained popularity and is now one of the most common surgical treatment for POP. While concomitant supracervical hysterectomy is very popular at the time of sacrocolpopexy in some part of the world, it is rarely performed in many European countries. Robust data are still lacking to determine the interest of concomitant supracervical hysterectomy during robotic sacrocolpopexy.  The aim of the present study was to compare the outcomes of robotic sarcrocolpopexy with or without supercarvical hysterectomy.

The charts of all consecutive patients who underwent minimally invasive sacrocolpopexy for POP at a single academic center between 2013 and 2023 were included in a retrospective study. The patients having undergone laparoscopic sacrocolpopexy, those with a history of previous hysterectomy and those with autologous sacrocolpopexy were excluded. The remaining patients were included for analysis and divided in two groups: with (HYST) vs without (no HYST) supracervical hysterectomy. There was two consecutive eras. From 2013 to 2017, supracervical hysterectomy was never performed due to local habits. From 2018 to 2023, supracervical hysterectomy was offered to every menopausal patient with an apical component to the POP or with any fibroids or enlarged uterus on preoperative ultrasound.

Out of 197 minimally invasive sacrocolpopexy, 88 were included in the present analysis: 39 in the HYST group and 49 in the no-HYST group. The only statistically significant difference at baseline between the two groups was the higher proportion of grade 3 or 4 uterine prolapse in the HYST group (35.1% vs. 10.2%; p=0.01). The postoperative complications rates were similar in both groups (16.7% vs. 18.4%;0.84) but length of hospital stay which was shorter in the HYST group (median: 1 vs 2 days; p=0.02). After a median follow-up of 12 months in the two groups (p=0.90), the subjective success rate were similar (96.6% vs. 92.2%; p=0.44). The rate of anatomical success for cystocele did not differ significantly between both groups at last follow-up (84% vs. 75.6%; p=0.42) and likewise for the apical component (96% vs.97.5%;p=0.73). The rate of recurrent POP requiring surgical reintervention was comparable between both groups (2.9% vs. 4.3%;p=0.74). There was no mesh extrusion or exposure in any of the two groups.

In the present study, we did not demonstrate a benefit for supracervical hysterectomy at the time of sacrocolpopexy. However, we did not observe an increased morbidity in the HYST group suggesting that it may not exist anymore beyond the learning curve in the robotic era.

Larger prospective studies with long term follow-up are needed to determine the role of supracervical hysterectomy during robotic sacrocolpopexy.

Continence 12S (2024) 101501
DOI: 10.1016/j.cont.2024.101501