Introduction: The single-port robotic platform is a novel platform that allows for intra-abdominal robotic-assisted surgery using up to three articulating arms and an articulating camera, through a 2-3 cm incision, which has opened new ways for both the patients and surgeons seeking improved perioperative outcomes such as reduced postoperative pain and recovery time, as well as cosmesis. Along with its quick global adoption, published reports of gynecologic procedures using the single-port robotic platform include hysterectomy, myomectomy, ovarian cystectomy and sacrocolpopexy (SCP). However, literatures evaluating the outcomes of single-port robotic SCP (SPR-SCP) is very limited, necessitating an evaluation of this new platform for pelvic reconstructive surgery.

Objectives: To assess intraoperative and postoperative complication rates, along with perioperative and surgical outcomes, following single-port robotic sacrocolpopexy (SPR-SCP).

Methods: This retrospective case series included 200 patients who underwent SPR-SCP to treat Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 symptomatic prolapse between April 2020 and August 2023 by a single surgeon. Intraoperative, postoperatvie complications and perioperative outcomes were evaluated for all the patients, while surgical outcomes for 74 patients were assessed at 1-year follow-up. Intraoperative complications included adverse events during procedures, such as cystotomy. Perioperative outcomes included estimated blood loss, total operation time (from incision to closure) and length of hospital stay. Mesh erosion and umbilical wound hernia rates were noted as postoperative complications. Surgical failure was defined as the presence any of the following: (1) the presence of vaginal bulging symptom, (2) any prolapse beyond the hymen, or (3) retreatment for prolapse.

Results: During the study period, 200 SPR-SCP were performed. The median age and body mass index were 65.0 yrs and 24.6 kg/m2., respectively. Most patients had POPQ stage 3 or 4 prolapse and underwent concomitant total hysterectomy. The median total operation time was 212.0 min, and no patient required conversion to laparoscopy or laparotomy. The intraoperative cystotomy rate was 2.5% (5/200), and one patient had a blood transfusion due to presacral vessel injury (0.5%, 1/200). Postoperative complications of mesh erosion and wound hernia were 0.5% (1/200) and 2.0% (4/200), respectively. At 1-year postoperatively, the rate of composite surgical failure was 9.5% (7/74), with a 5.4% (4/74) anatomic recurrence rate. No patient experienced apical prolapse recurrence, and one received anterior colporrhaphy for anterior compartment prolapse recurrence.

Conclusions: Single-port robotic sacrocolpopexy (SPR-SCP) is safe and feasible novel technique in performing SCP, with low intraoperative and postoperative complication rates, and favorable perioperative outcomes. Moreover, 1-year surgical outcomes of pelvic organ prolapse are also acceptable and comparable to preexisting modalities.

Based on this large case series, SPR-SCP can offer safe and effective option to correct apical prolapse with minimal abdominal wall trauma.

Continence 12S (2024) 101506
DOI: 10.1016/j.cont.2024.101506