Grigoryan Bagrat, Kasyan George, Shapovalenko Roman, Popov Alexander, Pushkar Dmitry
Botkin Hospital Moscow Urology Center, Moscow, Russia.
Urology Department, Russian University of Medicine, Moscow, Russia.
Int Urogynecol J. 2025 Jul;36(7):1355-1372. doi: 10.1007/s00192-025-06158-2. Epub 2025 Jun 12.
The aim of this study is to evaluate the safety of robot-assisted sacrocolpopexy (RSP) compared with other approaches of sacrocolpopexy and vaginal surgery in pelvic organ prolapse (POP).
The search was performed on studies published prior to May 2024. The inclusion criteria were randomized and nonrandomized trials involving adult women with POP. Exclusion criteria comprised other forms of intervention treatments and articles lacking comparative analyses. This study adhered to the Population, Intervention, Comparison, and Outcome framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist, and was registered in the Prospective Register of Systematic Reviews.
The systematic review included 36 studies, whereas the meta-analysis included 30 studies. RSP demonstrated superior outcomes compared with laparoscopic (LSP), abdominal (ASP), and vaginal surgery (VS) approaches, with fewer perioperative complications (p < 0.00001 for RSP vs ASP; p = 0.01 for RSP vs VS), reduced blood loss (total p < 0.00001 for RSP vs LSP, ASP, and VS), and shorter hospital stays (p = 0.003 for RSP vs LSP; p = 0.27 for RSP vs VS). Additionally, RSP had fewer surgical conversions than LSP (p = 0.01). However, LSP and VS showed significantly shorter operation times than RSP (p < 0.00001).
Robot-assisted sacrocolpopexy may offer advantages in reducing blood loss compared with VS and shortening hospital stays compared with LSP. Sensitivity analyses, however, revealed no significant differences in perioperative complications or blood loss compared with LSP and ASP. Further high-quality randomized studies are necessary to confirm the safety and efficacy of RSP.
本研究旨在评估机器人辅助骶骨阴道固定术（RSP）与其他骶骨阴道固定术及盆腔器官脱垂（POP）阴道手术方法相比的安全性。
检索了2024年5月之前发表的研究。纳入标准为涉及成年POP女性的随机和非随机试验。排除标准包括其他形式的干预治疗和缺乏比较分析的文章。本研究遵循人群、干预、对照和结局框架、2020年系统评价和Meta分析优先报告清单，并在系统评价前瞻性注册库中注册。
系统评价纳入36项研究，Meta分析纳入30项研究。与腹腔镜（LSP）、开腹（ASP）和阴道手术（VS）方法相比，RSP显示出更好的结果，围手术期并发症更少（RSP与ASP相比，p < 0.00001；RSP与VS相比，p = 0.01），失血减少（RSP与LSP、ASP和VS相比，总体p < 0.00001），住院时间更短（RSP与LSP相比，p = 0.003；RSP与VS相比，p = 0.27）。此外，RSP的手术中转率低于LSP（p = 0.01）。然而，LSP和VS的手术时间明显短于RSP（p < 0.00001）。
与VS相比，机器人辅助骶骨阴道固定术在减少失血方面可能具有优势；与LSP相比，在缩短住院时间方面具有优势。然而，敏感性分析显示，与LSP和ASP相比，围手术期并发症或失血无显著差异。需要进一步的高质量随机研究来证实RSP的安全性和有效性。
