Strauss Mila, Kennes Lieven N, Dombrowski Janina, Stickeler Elmar, Gräf Charlotte, Lube Katharina, Hillmeyer Alessia, Najjari Laila
Department of Obstetrics and Gynecology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Economics and Business Administration, University of Applied Sciences Stralsund, Stralsund, Germany.
Front Surg. 2025 Aug 29;12:1625404. doi: 10.3389/fsurg.2025.1625404. eCollection 2025.
Laparoscopic and robotic-assisted sacrocolpopexy are established techniques for pelvic organ prolapse (POP) repair, but their performance in patients with higher age, BMI, and parity remains underexplored.
In this retrospective single-center study, we analyzed 162 women undergoing minimally invasive sacrocolpopexy between 2010 and 2023: = 104 via laparoscopic sacrocolpopexy (LSC) and = 58 via robotic-assisted sacrocolpopexy (RASC). Patients were included if they had symptomatic or asymptomatic POP stage II or higher. Primary outcomes were surgical duration and length of postoperative hospital stay; secondary outcomes included intra- and postoperative complications. Regression analyses were used to assess the influence of age, BMI, and number of births.
Mean patient age was 64 ± 11.2 years. Surgical duration increased significantly with BMI (+2.82 min/unit, 95% CI: 0.50, 5.14, = 0.0177) and parity (+9.8 min/birth, CI: 0.56, 19.14, = 0.0379) in the LSC group, but not significantly in RASC (Surgical duration: (+2.00 min/unit, 95% CI: -0.53, 4.63, = 0.1167; parity: + 8.7 min/birth, 95% CI: 0.50, 5.14, = 0.0698). Postoperative stay was significantly prolonged with higher age (95% CI = 0.006, 0.057, = 0.0152), BMI (95% CI = 0.019, 0.154, = 0.0130), and number of vaginal births (95% CI = 0.008, 0.59, = 0.01) in LSC, while these associations were attenuated in RASC (age: 95% CI: -0.0213, 0.0249, = 0.876; BMI: -95% CI: -0.038, 0.060, = 0.667; vaginal birth: 95% CI = 0.10, 0.44, = 0.003). Overall complication rates exhibited no measurable difference between the groups (LSC 18%, RASC 19%). Complications were more frequent with fixation at the vaginal vault than the cervix.
Robotic-assisted sacrocolpopexy appears to offer greater procedural consistency in patients with advanced age, obesity, and higher parity. These findings support the selective use of robotic assistance in anatomically or clinically complex cases and add to the limited evidence guiding personalized surgical planning in POP repair.
腹腔镜和机器人辅助骶骨阴道固定术是治疗盆腔器官脱垂（POP）的成熟技术，但它们在年龄较大、体重指数（BMI）较高和多产的患者中的表现仍未得到充分研究。
在这项回顾性单中心研究中，我们分析了2010年至2023年间接受微创骶骨阴道固定术的162名女性：104例通过腹腔镜骶骨阴道固定术（LSC），58例通过机器人辅助骶骨阴道固定术（RASC）。有症状或无症状的POP II期或更高分期的患者被纳入研究。主要结局指标为手术时间和术后住院时间；次要结局指标包括术中及术后并发症。采用回归分析评估年龄、BMI和分娩次数的影响。
患者平均年龄为64±11.2岁。在LSC组中，手术时间随BMI（+2.82分钟/单位，95%可信区间：0.50，5.14，P = 0.0177）和分娩次数（+9.8分钟/次分娩，可信区间：0.56，19.14，P = 0.0379）显著增加，但在RASC组中无显著增加（手术时间：+2.00分钟/单位，95%可信区间：-0.53，4.63，P = 0.1167；分娩次数：+8.7分钟/次分娩，95%可信区间：0.50，5.14，P = 0.0698）。在LSC组中，术后住院时间随年龄增加（95%可信区间 = 0.006，0.057，P = 0.0152）、BMI增加（95%可信区间 = 0.019，0.154，P = 0.0130）和阴道分娩次数增加（95%可信区间 = 0.008，0.59，P = 0.01）而显著延长，而在RASC组中这些关联减弱（年龄：95%可信区间：-0.0213，0.0249，P = 0.876；BMI：-95%可信区间：-0.038，0.060，P = 0.667；阴道分娩：95%可信区间 = 0.10，0.44，P = 0.003）。两组总体并发症发生率无显著差异（LSC组18%，RASC组19%）。阴道穹窿固定术的并发症比宫颈固定术更常见。
机器人辅助骶骨阴道固定术在高龄、肥胖和多产患者中似乎具有更高的手术一致性。这些发现支持在解剖学或临床复杂病例中选择性使用机器人辅助，并为POP修复中指导个性化手术规划的有限证据增添了内容。
