8881 Outcomes of Single Port Robotic Sacrocolpopexy Compared with Traditional Multi-Port Approaches

Abstract

Study Objective As technology continues to advance, surgeons must evaluate risks and benefits of new instrumentation. The single-port robotic (SPR) system is a new approach which is FDA-approved for urologic procedures but is not yet FDA-approved for gynecology. We believe the single-port robotic approach is beneficial for use in sacrocolpopexy. The goal of our study is to compare surgical outcomes for the SPR approach to multi-port approaches for sacrocolpopexy. Design Retrospective chart review, with primary outcome of operative time. Secondary outcomes include number and severity of adverse events. Setting Academic tertiary care hospital. Patients or Participants Fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018-2021. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single port (RSP). Interventions LMP, RMP, and RSP sacrocolpopexy with concomitant procedures. Measurements and Main Results All patients underwent at least one concomitant procedure. LMP had more concomitant procedures compared to RMP and RSP (p < 0.001). RMP had higher incidence of prior hysterectomy (p < 0.001) and prior vaginal surgery (p = 0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR = 2.23, p = 0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. Mean operative time was 3 hours for RSP, 3.3 hours for LMP, and 2.7 hours for RMP (p>0.05). Conclusion This retrospective study demonstrates feasibility and safety of the SPR approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger studies are indicated to better understand long-term outcomes. As technology continues to advance, surgeons must evaluate risks and benefits of new instrumentation. The single-port robotic (SPR) system is a new approach which is FDA-approved for urologic procedures but is not yet FDA-approved for gynecology. We believe the single-port robotic approach is beneficial for use in sacrocolpopexy. The goal of our study is to compare surgical outcomes for the SPR approach to multi-port approaches for sacrocolpopexy. Retrospective chart review, with primary outcome of operative time. Secondary outcomes include number and severity of adverse events. Academic tertiary care hospital. Fifty patients who underwent minimally invasive sacrocolpopexy with a single urogynecologist between 2018-2021. Patients were divided into three cohorts: laparoscopic multi-port (LMP), robotic multi-port (RMP), and robotic single port (RSP). LMP, RMP, and RSP sacrocolpopexy with concomitant procedures. All patients underwent at least one concomitant procedure. LMP had more concomitant procedures compared to RMP and RSP (p < 0.001). RMP had higher incidence of prior hysterectomy (p < 0.001) and prior vaginal surgery (p = 0.002) compared to LMP and RSP. There were no significant differences in age, BMI, ethnicity/race, pre-operative POPQ stage, number of prior laparoscopies/laparotomies, or prior hernia repair. Linear and Poisson regression models were used to assess between-group differences in the outcome measures while adjusting for confounders. LMP had significantly higher adverse event severity than RSP (RR = 2.23, p = 0.044). 62.5% of the RSP group had no adverse events. No other statistically significant differences were observed. Mean operative time was 3 hours for RSP, 3.3 hours for LMP, and 2.7 hours for RMP (p>0.05). This retrospective study demonstrates feasibility and safety of the SPR approach for sacrocolpopexy when compared with traditional multi-port approaches. Larger studies are indicated to better understand long-term outcomes.