Use of Novel Configuration with Suture Kit Device for Robotic-assisted Minimally Invasive Sacrocolpopexy

Abstract

<h3>Study Objective</h3> To assess safety and efficacy of performing robotic-assisted laparoscopic sacrocolpopexy (RA-SCP) using a four-arm robotic configuration and suture kit system. <h3>Design</h3> Retrospective case series. <h3>Setting</h3> Tertiary care referral center. <h3>Patients or Participants</h3> Patients undergoing RA-SCP with or without concomitant hysterectomy. <h3>Interventions</h3> All procedures were performed using four-arm robotic configuration and the Stitch Kit® polytetrafluoroethylene (PTFE) (Origami Surgical) suture kit device. The configuration included four 8 mm ports: one camera port and three working ports. No bedside assistant port was used. The Stitch Kit® PTFE, a canister with 6 polytetrafluoroethylene sutures and a separate compartment for used needles, was inserted into the abdominal cavity through a 8 mm umbilical skin incision prior to robotic docking. After suturing, each needle was replaced in the canister. The canister was closed and removed through the umbilical port site at the end of the case. No fascial closure of port sites was required. <h3>Measurements and Main Results</h3> 422 patients underwent RA-SCP for pelvic organ prolapse from 2018-2021. Mean age was 60 ± 10 years and mean BMI was 27 ± 6 kg/m². Most patients had stage III prolapse (73%) and underwent concomitant total hysterectomy (70%). 99% (n=416) of cases were completed robotically; of the 1% (n=6) not completed robotically, 5 had sacrospinous ligament suspensions due to presence of prior eroded foreign body material or extensive adhesions and 1 was aborted due to colorectal mass. The Stitch Kit® canister was successfully inserted and removed in all cases completed robotically with correct needle counts. 337 (80%) of participants followed up at 3 months. No umbilical or port site hernias were reported. <h3>Conclusion</h3> Our case series illustrates that RA-SCP can be performed safely using a four-arm robotic configuration with a suture kit device. This setup eliminates the need for any incisions greater than 8 mm and an assistant port. These modifications allow for surgical efficiency without compromising patient outcomes.