Principal surgical steps of the robotic-assisted lateral suspension for the treatment of concomitant advanced apical-anterior pelvic organ prolapse

Background: Robotic-assisted lateral suspension (RALS) to the abdominal wall using a titan-covered T-shaped mesh is a practical alternative procedure of minimally invasive sacrocolpopexy where the robotic platform may deal exclusive pros, especially for the resolution of concomitant anterior and apical pelvic organ prolapse (POP). We aimed to retrospectively define the surgical procedure and the medium and long-term outcomes of a consistent series of RALS in a tertiary referral center for the minimally invasive POP treatment. Methods: The first series of 93 symptomatic patients with concomitant IIIrd or IVth stage anterior and apical prolapse underwent RALS between September 2014 and September 2018. Results: RALS was successfully executed by a full robotic technique without adverse events and no conversion in traditional laparoscopic or open approach in all patients. The mean operative time was 129±34 minutes. The surgery was extremely well-tolerated and resulted in an overall objective cure rate of 88.8% for the anterior compartment and 93.6% for the apical compartment POP-associated symptoms and improvements of POP- and incontinence-related quality of life scores (PQOL and IIQ7) at 2 years follow-up. Conclusions: Robotic reparation of POP through RALS is a novel procedure with promising outcomes for treating high-stage concomitant anterior and apical pelvic defects. Whether the robotic assistance may offer specific advantages in this reconstructive procedure achieving optimally tailored anatomic reconstruction and allowing a good flow of the surgical steps such as deep pelvic dissection and suturing, is still a matter of debate.