First robotic approach of tendon transplantation for apical prolapse repair – a clinical feasibility study

Abstract

Introduction. Pelvic organ prolapse (POP) is a frequent condition affecting more than 40% of parous women. The objective of this study was to evaluate the feasibility and safety of the first robotic-assisted sacrocervicopexy using a semitendinosus tendon autograft (rSC-T) for treatment of apical prolapse. Methods. 10 women with symptomatic ≥ stage II apical prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q), who underwent rSC-T. Primary objective was to evaluate the feasibility and safety of the procedure and to describe the novel robotic-assisted approach. Secondary objective was the objective cure rate according to POP-Q. Results. We included 10 patients, 8 with uterine prolapse stage II and 1 with apical vault prolapse stage III. Concomitant procedures, i.e. robotic-assisted supracervical hysterectomy (8), anterior (10) and posterior repair (5) and Burch colposuspension (3) were performed. Mean operative time (range) was 155 min. (115-246). Mean blood loss (range) was 27 ml (20-50). All operations were performed successfully without any complication. Duration of hospital stay was according to standard. After a mean follow-up time (range) of 10 weeks (1-26), the objective cure rate was 100% for apical, 90% for anterior and 90% for posterior compartment prolapse. Conclusions. This case series show the feasibility and safety of the robotic approach to apical prolapse repair using a semitendinosus tendon autograft (rSC-T), with low complication rates and excellent short-term objective outcomes. The robotic approach was very suitable for the different key steps of the procedure. To further evaluate the efficacy and safety of this procedure we will initiate a prospective multicenter register study.