Robot-assisted Laparoscopic Sacrocolpopexy Research Articles

Perioperative adverse events after minimally invasive abdominal sacrocolpopexy

Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events. This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data. Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P < .001), and osteomyelitis (5.6% vs 0, respectively; P < .001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not. Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.

Indocyanine green for intraoperative localization of ureter

Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG. Intraurethral injection of ICG and visualization under NIR light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery.

Peri- and Postoperative Outcomes after Robotic-Assisted and Conventional Laparoscopic Sacrocolpopexy

Peri- and Postoperative Outcomes after Robotic-Assisted and Conventional Laparoscopic Sacrocolpopexy

Robotic Sacrocolpopexy for the Management of Pelvic Organ Prolapse

Transabdominal sacrocolpopexy is a definitive treatment option for vaginal vault prolapse with durable success rates. The aim of our study was to review subjective and objective outcomes including complications after robotic assisted laparoscopic sacrocolpopexy for the repair of symptomatic pelvic organ prolapse. Single-site retrospective cohort study of women undergoing robotic assisted laparoscopic sacrocolpopexy with and without concomitant robotic assisted supracervical hysterectomy was performed. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7 questionnaires were used preoperatively and postoperatively to evaluate patient subjective data, respectively. We established a strict improvement of greater than 70% on questionnaire's total score to determine clinical improvement. Complications were assessed at 6 months and 127 women were included in our review. Mesh extrusion occurred in 3 (2.4%) patients. Other complications reported were bowel injury (2.4%), readmission rate (2.4%), wound infection (1.6%), and postoperative hernia at port site (1.6%). Objective and subjective outcomes were assessed at 1 year in 92 women. Although there was no recurrent apical prolapse at 1 year, anterior prolapse was present in 7 patients. Clinical improvement was present in 72% by Pelvic Floor Impact Questionnaire-7 and in 68% by Pelvic Floor Distress Inventory-20. Predictors of poor clinical outcomes were lysis of adhesions (OR, 5.83; 95% confidence interval [CI], 1.2-27.4; P = 0.026), urethrolysis (OR, 11.91; 95% CI, 1.2-117.9; P = 0.034), current smoking (OR, 7.9; 95% CI, 1.1-58.7; P = 0.042), and older age (OR, 1.1; 95% CI, 1.0-1.18; P = 0.044). Robotic assisted laparoscopic sacrocolpopexy represents a safe and effective surgical therapy to manage symptomatic apical pelvic organ prolapse. Serious complication rates are low but not rare when assessing short-term outcomes.

Growing evidence for robotic prolapse surgery

Robot-assisted laparoscopic sacrocolpopexy (RSC) offers the advantages of minimally invasive surgery, especially to surgeons who do not have laparoscopic expertise. A recently published series adds to the growing body of evidence that RSC achieves comparable outcomes to the open approach with minimal morbidity.

Robotic-assisted laparoscopic sacrocolpopexy for stage III pelvic organ prolapse

Abdominal sacrocolpopexy is the gold standard treatment for pelvic organ prolapse and can be performed laparoscopically. Robotic assistance allows optimal dissection and placement of the prosthesis. We present a video of our technique along with the results on 90 patients. We perform a posterior dissection down to the levator muscles and an anterior dissection down to the trigone. The meshes are made of polyester (mersuture®). The posterior mesh is sutured to the levator muscles, to the rectum above the anorectal junction, below the uterosacral ligaments, and to the isthmus/cervix. The anterior mesh is sutured to the vagina and the isthmus/cervix and attached to the promontory with a tension measured through a vaginal exam. We operated on 90 patients. There was an additional procedure in 71 cases (either subtotal hysterectomy, adnexectomy, adhesiolysis, or rectopexy). The mean operative time was 246 min (180-415). Perioperative complications were one vaginal effraction and a case of sigmoidal perforation during an adhesiolysis. Early complications were two cases of bowel hernia through port sites. The mean hospital stay was 3.48 days (2-11). The mean follow-up is 15.6 months (range 1-45). Six patients have a persistent stage II prolapse. We observed no retraction of the prosthesis and no dyspareunia. With this technique we performed a complete treatment for severe prolapse by a minimally invasive approach with a low rate of recurrence at this point.

Implementation of a new procedure: laparoscopic versus robotic sacrocolpopexy

The purpose of this study was to compare the implementation process and the learning curves of laparoscopic and robotic-assisted laparoscopic sacrocolpopexy (LSC and RSC, respectively) for vaginal apex prolapse. A retrospective study of the first 40 LSC and first 40 RSC procedures performed at one medical center. The primary outcomes were intraoperative bleeding, operative time, and hospitalization. Secondary outcomes were surgical complications. The independent t test, paired t test, χ(2) test, Fisher's exact test and Pearson's correlation were used to analyze the data. We assumed that 34 participants were needed in each group to detect a 50 ml or more difference in estimated blood loss between laparoscopic and robotic surgeries, Age, preoperative pelvic organ prolapse quantification (POPQ) staging, and concomitant medical disorders did not differ significantly by procedure type. For LSC and RSC, the mean estimated intraoperative blood loss was 206 ± 107 and 48 ± 55 ml, P < 0.0001; mean operative times were 176 (110-380 min) and 186 (105-345 min), P = 0.34; and mean length of hospital stay, 3.8 ± 1 and 2.4 ± 1 days, P < 0.0001, respectively. Adverse events were rare, not severe, and did not differ significantly by procedure type. RSC and LSC are feasible procedures with acceptable complication rates. RSC enables operating more anatomically with less bleeding.

Complex Rectovaginal Fistulas After Pelvic Organ Prolapse Repair With Synthetic Mesh

The use of synthetic mesh for transvaginal pelvic organ prolapse (POP) repair is associated with the rare complication of mesh erosion into hollow viscera. This study presents a single-institution series of complex rectovaginal fistulas (RVFs) after synthetic mesh-augmented POP repair, as well as strategies for identification and management. Institutional review board approval was obtained for this retrospective study. Data were collected and analyzed on all female patients undergoing RVF repair from 2000 to 2011 at our institution. Thirty-seven patients underwent RVF repair at our multidisciplinary center for restorative pelvic medicine. Of these, 10 (27.0%) were associated with POP repairs using mesh. The POP repairs resulting in RVF were transvaginal repair with mesh (n = 8), laparoscopic sacrocolpopexy with concomitant traditional posterior repair (n = 1), and robotic-assisted laparoscopic sacrocolpopexy (n = 1). Time to presentation was an average of 7.1 months after POP repair. Patients underwent a mean of 4.4 surgeries for definitive RVF repair, with 40% of patients requiring a bowel diversion (3 temporary ileostomies and 1 long-term colostomy). Mean follow-up time after last surgery was 9.2 months. On follow-up, 1 patient has a persistent fistula with vaginal mesh extrusion. One patient has persistent pelvic pain. This series highlights the significant impact of synthetic mesh complications in the posterior compartment. These complications should be cautionary for synthetic graft use by those with limited experience, particularly when an alternate choice of traditional repair is available. When symptoms of RVF are present, collaboration with a colon and rectal specialist should be initiated as soon as possible for evaluation and definitive repair.

Sakrokolpopexie – pro robotisch

Abdominal sacrocolpopexy is a standard procedure for the correction of pelvic organ prolapse of all three compartments and can also be performed minimally invasively without compromising efficacy as by open techniques. In comparison to conventional laparoscopy robotic-assisted laparoscopic sacrocolpopexy benefits from several technical stand-alone features, such as three-dimensional view, increased degrees of freedom through angulated instruments, tremor filter and up and down scaling of instrument movements. These advantages facilitate preparation of the vesicovaginal and rectovaginal spaces as well as suturing and reperitonealization, which should lead to decreased operation time and anesthesia time in extreme Trendelenburg position. Surgeon also benefit from the much more ergonomic working conditions of the da Vinci® system: however, comparative studies are rare and conclusions are preliminary. The German reimbursement system (DRG) does not adequately cover da Vinci expenses which, despite the obvious advantages represents the most significant obstacle in the propagation of this technique.

Subjective and objective outcomes 1year after robotic-assisted laparoscopic sacrocolpopexy.

We aimed to assess the subjective and objective outcomes 1year after robotic sacrocolpopexy using a type I polypropylene mesh. This was a case series of 64 patients who underwent a robotic-assisted laparoscopic sacrocolpopexy using a type I monofilament polypropylene mesh coated with hydrophilic porcine collagen. Objective and subjective outcomes were assessed using the pelvic organ prolapse quantification (POP-Q), the short forms of the Pelvic Floor Impact Questionnaire (PFIQ 7) and the Pelvic Floor Distress Inventory (PFDI-20). Outcome measures were collected pre-operatively and 1year post-operatively on all but one patient, who was lost to follow-up. Paired comparisons between pre- and post-operative outcomes were performed using the Wilcoxon signed rank test. At 1year, POP-Q stage II or greater and loss of follow-up were considered to be surgical failure. The "surgical cure" rate was 89%. We observed three distal anterior failures, two distal posterior failures and one apical failure, and one patient was lost to follow-up. We found significant differences between pre- and post-operative POP-Q measurements (p<0.001) and PFDI-20/PFIQ-7 total scores (p<0.001). Robotic sacrocolpopexy using this polypropylene mesh resulted in significant improvements in subjective and objective outcome measures at 1year.

The case for conventional laparoscopic sacrocolpopexy

Paraiso et al. found no difference in anatomic or functional outcomes at 6 months postoperatively, length of hospital stay, or pain medication requirements after randomizing 67 patients with post hysterectomy vaginal vault prolapse to receive conventional versus robot-assisted laparoscopic sacrocolpopexy (RALSC). They did find greater postoperative pain scale scores at 3–6 weeks postoperatively and days of non-steroidal anti-inflammatory drug use favoring conventional laparoscopy. The operative times were significantly greater for RALSC (227±47 vs 161±47 min, mean difference 67 min, p<0.0001) [1]. RALSC cost more than conventional laparoscopic sacrocolpopexy (CLSC) with a mean difference of $2,196.00 (95%CI $660–3,732), driven primarily by the differences in technical costs associated with the procedures [2]. There is no realistic scenario where RALSC could cost less than CLSC. Robotic operative times would have to be reduced to 149 min from a published estimate time of 328 min and laparoscopic operative time would have to remain unchanged at 269 min to achieve cost equivalence. Robotic disposables would have to cost less than $2,132 from a published cost estimate of $3,293 and laparoscopic disposables would have to increase to more than $3,413 from $2,244 to achieve a lower cost for RALSC [3]. Currently there are no data to support the use of robot assistance over conventional laparoscopy for any surgical procedure. Maeso et al. identified 6 published randomized clinical trials (four fundoplications, one cholecystectomy, one Roux-en-Y gastric bypass) of 31 studies that met inclusion criteria for a systematic review and meta-analysis of the efficacy of the Da Vinci® Surgical System in abdominal surgery compared to conventional laparoscopy. None of the six published randomized clinical trials identified any outcomes that favored the Da Vinci® Surgical System except for the gastric bypass trial that found shorter operating room times for a new laparoscopy fellow presumably naive to either approach [4]. The Cochrane Collaboration reviewed five randomized clinical trials comparing robot-assisted laparoscopic cholecystectomy to conventional laparoscopy and found no significant advantage of robotic assistance for morbidity, conversion to open cholecystectomy, total operating time, or hospital stay [5]. Baik performed the first randomized clinical trial comparing robotic low anterior resection to a conventional laparoscopic approach and found no statistical difference in postoperative complications, number of harvested lymph nodes, resection margins, or mesorectal grading [6]. Morino randomized 20 consecutive patients requiring adrenalectomy to robot assisted versus conventional laparoscopy and found differences in operative time, conversion to open procedure, and perioperative morbidity that favored conventional laparoscopy. The total cost of the robot procedure was $3,467 compared to $2,737 for conventional laparoscopy (p<0.01) [7]. The Da Vinci® Surgical System has gained acceptance among the medical community because it shortens the learning curve for surgeons interested in performing minimally invasive procedures. Hospitals are purchasing these systems to meet the demand for minimally invasive procedures and maintain an advantage over their competition for surgical cases despite a lack of beneficial evidence and increased costs for robot assistance compared to conventional laparoscopy. The value of Intuitive Surgical, Inc. (Da Vinci® Surgical System) stock has grown 563% Further contributions to this debate can be found at doi:10.1007/ s00192-011-1618-6 and doi:10.1007/s00192-011-1619-5

Résultats de la promontofixation par voie laparoscopique robot-assistée pour la prise en charge des prolapsus urogénitaux : analyse de la littérature

Laparoscopic sacral colpopexy (LSCP) is one of the gold standard surgical treatment for the management of urogenital prolapse. Robot-assisted laparoscopic sacrocolpopexy (RALSCP) is an alternative surgical access which has been recently proposed. The aim of the current study was to report the functional results obtained after RALSCP. [corrected] A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: robotic; robot; sacrocolpopexy; sacralcolpopexy. Clinical cases and series of less than five cases were spontaneously not selected herein. Overall, 12 series in published between September 2004 and September 2011 which included 350 female patients were selected. The mean age was 63 years old with a pelvic organ prolapse of stage 3 to 4 in the Baden Walker classification. The mean operative time of the RALSCP was 207 minutes with a conversion rate of 3,4% and an intraoperative complication rate of 4,6%. The mean length of hospital stay was 3 days and the perioperative complication rate of 7,1%. The success rate of the RALSCP was 97% and the vaginal erosion rate was 2,5% with a median follow-up of 13,5 months. The mid-term functional results obtained after RALSCP were equivalent to those obtained with the LSCP approach. However, there is no prospective randomized comparison available between the two access so far. In addition, the experience with RALSCP remains limited due to the important cost that the robotic access generates.

Laparoscopic Compared With Robotic Sacrocolpopexy for Vaginal Prolapse

To compare conventional laparoscopic and robotic-assisted laparoscopic sacrocolpopexy for vaginal apex prolapse. This single-center, blinded randomized trial included participants with stage 2-4 posthysterectomy vaginal prolapse. Participants were randomized to laparoscopic or robotic sacrocolpopexy. The primary outcome was total operative time from incision to closure. Secondary outcomes were postoperative pain, functional activity, bowel and bladder symptoms, quality of life, anatomic vaginal support, and cost from a health care system perspective. A total of 78 patients enrolled and were randomized (laparoscopic n=38; robotic n=40). Total operative time was significantly longer in the robotic group compared with the laparoscopic group (+67-minute difference; 95% confidence interval [CI] 43-89; P<.001). Anesthesia time, total time in the operating room, total sacrocolpopexy time, and total suturing time were all significantly longer in the robotic group. Participants in the robotic group also had significantly higher pain at rest and with activity during weeks 3 through 5 after surgery and required longer use of nonsteroidal anti-inflammatory drugs (median, 20 compared with 11 days, P<.005). The robotic group incurred greater cost than the laparoscopic group (mean difference +$1,936; 95% CI $417-$3,454; P=.008). Both groups demonstrated significant improvement in vaginal support and functional outcomes 1 year after surgery with no differences between groups. Robotic-assisted sacrocolpopexy results in longer operating time and increased pain and cost compared with the conventional laparoscopic approach.

33 Robot-assisted laparoscopic sacrocolpopexy: results of the learning curve compared to standard laparoscopic cases for a trained robotic urologist

33 Robot-assisted laparoscopic sacrocolpopexy: results of the learning curve compared to standard laparoscopic cases for a trained robotic urologist

Severe Acidosis During Laparoscopic Repair of Pelvic Organ Prolapse and Incontinence

The creation and maintenance of a carbon dioxide pneumoperitoneum to allow a laparoscopic approach to surgery for pelvic organ prolapse has been associated with hypercapnea and respiratory acidosis. We present a case report of a 68-year-old patient who developed severe acidosis during a robotic-assisted laparoscopic sacrocolpopexy and discuss a practical approach to surgical and anesthetic decision making.

Advances in urogynaecological robotic surgery

• Urogynaecology is a subspecialty practiced by both urologists and gynaecologists specialised in treating women with pelvic floor disorders and urinary incontinence. • While urogynaecology covers a vast range of disorders, two disorders frequently managed by urogynaecologists are pelvic organ prolapse (POP) and pelvic fistulae. • Surgical intervention is often the treatment option for both POP and pelvic fistulae after all conservative options have been attempted. The daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has applications for the minimally invasive surgical management of POP and pelvic fistulas. • The following review will address the development and current state of robotic assistance in treating these disorders.

Prospective comparison of short-term functional outcomes obtained after pure laparoscopic and robot-assisted laparoscopic sacrocolpopexy

To prospectively compare short-term functional outcomes achieved by laparoscopic or robot-assisted sacrocolpopexy for pelvic organ prolapse. We prospectively collected clinical and operative data over 24months for female patients who underwent either pure laparoscopic sacrocolpopexy (LSCP) or robot-assisted laparoscopic sacrocolpopexy (RALSCP). Clinical data included age, BMI and assessment of PFDI-20 score. Perioperative data included operative time and complications. Post-operative outcomes included hospital stay, length of catheterisation, pain and functional outcomes as assessed by clinical examination and PFDI-20 score assessment. Overall, 67 women with a median age of 65 were included: 47 in the LSCP arm and 20 in the RALSCP arm. RALSCP was superior in terms of blood loss (median 55mls vs. 280; P=0.03) and strict operative time (median 125min vs. 220; P<0.0001), but this time advantage was nullified when comparing overall operating room time (215min vs. 220). With a median follow-up of 16months, the overall anatomic repair rate was 98.5%, and there was an improvement in overall PFDI-20 score before and after surgery (P=0.001) but with no difference between the two surgical approaches. RALSCP allows for a safe and effective repair of pelvic organ prolapse in female patients. Whilst being equivalent to LSCP in terms of functional outcome, it is superior in terms of blood loss and strict operative time. These results are based on short-term assessment, and further studies of larger populations with longer follow-up and objective assessments of outcome are needed to make any definitive statement.

Long-Term Outcomes after Robotic Sacrocolpopexy in Pelvic Organ Prolapse: Prospective Analysis

Objective: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. Methods: We conducted a prospective analysis of our series of robotic sacrocolpopexy. Inclusion criteria: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. Results: 31 consecutive procedures were included. Mean patient age was 65.2 (50–81) years. Mean operating room time was 186 (150–230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16–33) months. Conclusions: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.

Long-term outcomes of robotic-assisted laparoscopic sacrocolpopexy with a minimum of three years follow-up.

We describe efficacy and safety of robotic-assisted laparoscopic vaginal vault prolapse repair with long-term follow-up. We reviewed the records of 40 consecutive patients with posthysterectomy vaginal vault prolapse who underwent a robotic-assisted laparoscopic sacrocolpopexy at our institution between September 2002 and September 2006. Patient analysis focused on complications, patient satisfaction, and morbidity, with a minimum of 36months' follow-up. Median follow-up was 62months (range 36-84) and mean age was 67 (43-83)years. Mean operating time was 3.1 (2.15-5)h with a median operating time of 2.9h. All but four were discharged home on postoperative day one; three patients left on postoperative day two and one left on postoperative day seven. Three developed recurrent grade 3-4 rectoceles and two vaginal extrusion of mesh. Thirty-eight of the 40 patients (95%) were satisfied with their outcome. Robotic-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the decreased morbidity of laparoscopy. We found a short hospital stay, low complication rates, and high patient satisfaction with a minimum of 3years' follow-up.

Robotic-Assisted and Laparoscopic Sacrocolpopexy

: To compare operative times, hospital costs, and surgical outcomes for robotic-assisted laparoscopic sacrocolpopexy (RALSC) and laparoscopic sacrocolpopexy (LSC). : A retrospective cohort study of 104 subjects who underwent RALSC (n = 43) or LSC (n = 61) for vaginal vault prolapse was performed. The primary outcomes were operative time and hospital costs. The secondary outcomes included blood loss, complications, and objective cure rates. χ and t tests were used. : The mean operative time was longer in RALSC than in LSC (281 ± 58 vs 206 ± 42 minutes; P < 0.001) with setup time accounting for only 9 minutes of this difference. Direct costs (expressed in cost units) for hospital stay were similar (437 ± 88 vs 450 ± 119 units; P = 0.738) while surgical costs remained higher for RALSC (2724 ± 413 vs 2295 ± 342 units; P < 0.01). Blood loss and complications were similar, and objective cure was not significantly different for RALSC vs LSC (90% vs 80%, P = 0.19). : Robotic-assisted laparoscopic sacrocolpopexy achieves similar perioperative outcomes compared to LSC with increased surgical time resulting in increased costs.