2025 Volume 21 Issue 1 Pages 26-32
We implemented a four-port robot-assisted sacrocolpopexy (RSC) without a retraction arm.
Endoscope was inserted through the umbilicus, with 8 mm instrument cannulas placed 7 cm to the left and right of the umbilicus, and a 13 mm assistant port positioned 7 cm laterally from the right-side cannula. With the use of traction sutures, uterine manipulators, and optimized assistant techniques, we safely performed 101 consecutive RSCs with the French-style double-mesh. In four cases, a single anterior wall mesh RSC was performed due to past hysterectomy or intra-abdominal adhesions prolonging surgery.
The mean operative time was 183 minutes, and the mean console time was 131 minutes. Catheterization duration averaged 1.91 days, and postoperative hospitalization averaged 6.9 days. Residual urine volume showed no significant change, and uroflowmetry indicated no deterioration in voiding function. Patient-reported outcomes demonstrated significant improvements in lower urinary tract symptoms, overactive bladder symptoms, urinary incontinence, and psychological distress associated with pelvic organ prolapse.
Postoperative complications included four cases of umbilical wound infections and four cases of worsened stress urinary incontinence, of which two required mid-urethral sling surgery. Three cases of POP-Q stage II or higher recurrence were noted, with two undergoing repeat RSC. One patient required hernia repair for an incisional hernia.
Our four-port RSC demonstrates advantages in terms of minimal invasiveness, aesthetic outcomes, and cost-effectiveness.
