Eleonora Russo1; Magdalena Montt Guevara1; Andrea Giannini1; Paolo Mannella1, Giulia Misasi1; Maria Falcone1; Tommaso Simoncini1.

1 Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa Italy


Introduction and Hypothesis
Apical prolapse correction represents one of the major challenges in pelvic floor surgery. This study aims to evaluate the clinical outcome of robotic assisted lateral suspension (RALS) for the treatment of advanced anterior and apical pelvic organ prolapse (POP) in two different age groups.
We completed a prospective cohort study of 115 patients who underwent RALS to treat advanced apical and anterior prolapse. Clinical evaluation was performed with a simplified POP-Quantification system (POP-Q). Mean follow-up was 2.3±0.4 year. Primary outcome was objective and subjective cure; secondary outcome was reoperation rate for symptomatic recurrence, erosion rate and complications. Subjective cure was defined as absence of vaginal bulge. Patient’s satisfaction was measured using the Patient Global Impression of Improvement Scale (PGI-I).
Outcomes measures were observed in cohorts of two age groups (<70 years and ≥ 71 years).
Wilcoxon-matched-pairs signed rank test was performed to study the postoperative outcome and Kruskal Wallis followed by Dunn's multiple comparisons test was performed to analyze the followup.
Overall, there was a significant improvement in POP-Q score in all treated compartment with an overall objective cure rate of 88.7% for the anterior and 93.1% for the apical compartment (p <0.0001). The cumulative objective apical compartment cure rate were 91 % and 96.3% for patients aged <70 years ≥ 71 years, respectively, with a mean follow-up of 2.3±0.4 year. The reoperation rate for POP was 11.3%. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. No patient had major postoperative complication (Clavien-Dindo grade ≥3a). Mesh exposure rate was 1.5%. Sixty-seven patients participated in a telephone interview and the PGI-I scores showed a high medium-term patient satisfaction.
Lateral suspension offers an effective alternative to sacral suspension for the treatment of advanced apical and anterior POP. The robotic approach has satisfactory long-term anatomical outcomes with low rates of complications and good patient acceptability. Older patients undergoing robotic POP surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.

Table 1 Anatomical outcomes between 0, 6, 12 and 24 months based on clinical evaluation with a simplified POP-Q (Pelvic Organ Prolapse Quantification System) measurement. To identify the differences between pre- and postoperative outcomes, Wilcoxon matched-pairs signed rank one-tail test was used (). To analyze the outcomes between 0, 6, 12 and 24 months, Kruskal-Wallis test followed by Dunn's multiple comparisons test was performed (***: p<0.001 versus control). Data after surgery includes de novo prolapse (†). Data are presented as n (%); ns, not significant.

Figure 1 Kaplan-meier analysis on anatomic cure rate in two different age cohort