Robot-assisted, Laparoscopic and Transvaginal Surgery for Pelvic Organ Prolapse: a Comparative Retrospective Single-Center Study

Introduction and Hypothesis: Surgical management for pelvic organ prolapse (POP) is anything but standardized. We aimed to compare operating times, hospital stay, complications, and reinterventions following robot-assisted surgery (RAS), laparoscopy (LPS), or transvaginal surgery (TVS) for POP repair Methods: We retrospectively analyzed records from our hospital (January 2017–December 2023), including women receiving RAS or LPS (lateral suspension/sacrocolpopexy), or TVS (hysterectomy with POP repair). Cysto/rectopexies without hysterectomy were excluded. Surgical technique was determined from operative descriptions. Outcomes included: 1) operating time; 2) hospital stay; 3) complications; 4) reinterventions. Surgical route was the exposure variable. Adjusted linear, Poisson, logistic, and Cox regressions were used. A sub-analysis on lateral suspension and sacrocolpopexy was performed. Results: Of 583 women, 14.4% had LPS, 48.5% RAS, and 37.1% TVS. Adjusted models showed longer operating times for LPS vs RAS (+ 21.6 min, 95% CI + 8.7 to + 34.4) and shorter for TVS (-62.7 min, 95% CI -72.9 to -52.5). Hospitalization length was similar for LPS vs RAS, while longer for TVS (+ 0.5 days, 95% CI + 0.3 to + 0.7). Reinterventions and complications did not differ between groups. In sub-analysis, no differences in operating times and length of stay for lateral suspension were observed. For sacrocolpopexy, LPS was longer than RAS (+ 54.1 min, 95% CI + 30.3 to + 77.8); no difference in hospital stay emerged. Conclusions: RAS and LPS had similar safety and reintervention profiles. LPS was linked to longer operating times than RAS, and similar hospital stay. TVS had shorter operating times but required longer hospitalization. Sub-analyses suggested comparable performance for lateral suspension, while LPS sacrocolpopexy was more time-consuming than RAS.