I.D. KLYUSHNIKOV, T.A. GLEBOV, A.A. POPOV

 Moscow Regional Scientific Research Institute of Obstetrics and Gynecology named after Acad. V.I. Krasnopolsky, Moscow

Contact details:

Klyushnikov I.D. — PhD (Medicine), researcher of the Department of Operative Gynecology with Oncogynecology and Day Hospital

Address: 22a Pokrovka St., Moscow, Russian Federation, tel.: +7-926-5635-74-96, e-mail: endokmn@gmail.com

The purpose — to comprehensively assess the effectiveness of laparoscopic and robot-assisted sacrocolpopexy in women with isolated apical or combined POP.

Materials and methods. A single-center comparative non-randomized prospective study included female patients who underwent correction of POP with SCP via laparoscopic and robot-assisted approaches from 2013 to 2024. Inclusion criteria were the presence of stage III–IV apical POP according to the Pelvic Organ Prolapse Quantification System (POP-Q). Patients were divided into groups based on the chosen approach. Group I (laparoscopy) consisted of 315 patients, while group II (robotic access) had 272 participants.

Results. The median postoperative follow-up duration was 69.8 months (range: 31.4–106.5) and 79.3 months (range: 46.7–113.6) for groups I and II, respectively. The most common phenotype of disease recurrence was anterior vaginal wall descent, accounting for 6.9% (n = 22) and 6.3% (n = 17) observations in groups I and II, respectively (p = 0.72). Statistically significant differences were found in the frequency of recurrent vaginal bulge symptoms, demonstrating an advantage of robot-assisted SCP (7.3 vs 3.3%, p = 0.03). Despite this, repeat interventions aimed at correcting POP were performed in 3.1% of patients in the laparoscopic group and 1.8% in the robotic group (p = 0.11). Statistically significant differences were observed in intraoperative complications rates, which occurred in 6.0% (n = 19) and 2.6% (n = 7) of patients in groups I and II, respectively. Vaginal erosions were noted in 0.5% (n = 3/587) of operated women.

Conclusions. The research findings demonstrate high efficacy and safety of SCP as a method for surgical correction of POP, thus reducing the risk of repeated interventions. Although the selected approach did not affect anatomical and functional outcomes in most aspects, robot-assisted surgery offers better conditions for performing SCP. This method appears particularly justified in women with complicated surgical history, severe somatic diseases, and obesity. Minimally invasive SCP can still be considered the preferred option for women with isolated apical or combined posterior-apical POP.

Key words: pelvic organ prolapse, robotic surgery, sacrocolpopexy.

 Abbreviations: Pelvic Organ Prolapse (POP), Sacrocolpopexy (SCP), Pelvic Organ Prolapse Quantification system (POP-Q), Pelvic Organ Prolapse Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12 (PISQ-12), Minimal Clinical Important Difference (MCID), Visual Analogue Scale (VAS).

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