Comparison of Outcomes Between Single-Port Robotic Sacrocolpopexy and Multi-Port Approaches

INTRODUCTION: Minimally invasive techniques utilizing robotic and laparoscopic surgery have gained popularity in prolapse surgery over the past two decades. Among the gaining popularity for minimally invasive technology includes single-port robotic platforms. While the single-port approach has been approved for gynecologic procedures in other countries, it is not yet FDA approved in the United States. Additionally, limited research has been performed evaluating the feasibility and outcomes of the single-port robotic approach for prolapse surgery, including sacrocolpopexies. OBJECTIVE: To evaluate the feasibility and perioperative outcomes of single-port robotic (RSP) sacrocolpopexy in comparison to multi-port approach (RMP). METHODS: This was a retrospective cohort study set at an academic, tertiary care center. RSP sacrocolpopexies were performed by one urogynecolgy and reconstructive pelvic surgeon (UPRS). RMP sacrocolpopexies were performed by five URPS surgeons (2 urology, 3 OBGYN) within the same hospital. 164 patient charts were reviewed for those who had undergone a robotic sacrocolpopexy between 2018 and 2023. Average follow-up was 34 weeks postoperative (42 RMP, 11 RSP). All patients included underwent a robotic sacrocolpopexy. 126 patients underwent RMP approach, and 38 patients underwent RSP approach. Differences were tested using Wilcoxon rank sum tests, Fisher’s exact tests, or Cochran-Armitage trend tests. RESULTS: All patients underwent at least one concomitant procedure at the time of surgery, but those in the RSP group had a higher average number of concomitant procedures performed when compared to the RMP group (p<0.001). The incision to close time was shorter for RSP compared to RMP (mean 182 vs 220 minutes, p=0.004). RSP patients were more likely to have concomitant hysterectomies (p<0.001), salpingectomies (p=0.001), and/or oophorectomies (p=0.004) at the time of surgery. The mean hospital length of stay was shorter for the RSP group (mean 14 hours) compared to the RMP group (22 hours, p=0.005). There were no significant differences in age, BMI, ethnicity, preoperative POP-Q stage, re-operation rates, or prolapse recurrence between groups. The RMP group was more likely to have an adverse event (Clavien-Dindo) compared to RSP group (p=0.037), but no significant difference between the number (p=0.353) or severity (p=0.113) of adverse events between the two groups. CONCLUSIONS: This study demonstrates that single-port robotic sacrocolpopexy is safe and feasible. Larger prospective studies are needed to better demonstrate postoperative outcomes with the single-port approach.