title: Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial.
abstract: OBJECTIVE
  To compare conventional laparoscopic and robotic-assisted laparoscopic sacrocolpopexy for vaginal apex prolapse.
  
  
  METHODS
  This single-center, blinded randomized trial included participants with stage 2-4 posthysterectomy vaginal prolapse. Participants were randomized to laparoscopic or robotic sacrocolpopexy. The primary outcome was total operative time from incision to closure. Secondary outcomes were postoperative pain, functional activity, bowel and bladder symptoms, quality of life, anatomic vaginal support, and cost from a health care system perspective.
  
  
  RESULTS
  A total of 78 patients enrolled and were randomized (laparoscopic n=38; robotic n=40). Total operative time was significantly longer in the robotic group compared with the laparoscopic group (+67-minute difference; 95% confidence interval [CI] 43-89; P<.001). Anesthesia time, total time in the operating room, total sacrocolpopexy time, and total suturing time were all significantly longer in the robotic group. Participants in the robotic group also had significantly higher pain at rest and with activity during weeks 3 through 5 after surgery and required longer use of nonsteroidal anti-inflammatory drugs (median, 20 compared with 11 days, P<.005). The robotic group incurred greater cost than the laparoscopic group (mean difference +$1,936; 95% CI $417-$3,454; P=.008). Both groups demonstrated significant improvement in vaginal support and functional outcomes 1 year after surgery with no differences between groups.
  
  
  CONCLUSIONS
  Robotic-assisted sacrocolpopexy results in longer operating time and increased pain and cost compared with the conventional laparoscopic approach.
authors: From the Cleveland Clinic, Cleveland, Ohio.
authors: Marie Fidela R
authors: MFR
authors: Paraiso
authors: J Eric
authors: JE
authors: Jelovsek
authors: Anna
authors: A
authors: Frick
authors: Chi Chung Grace
authors: CCG
authors: Chen
authors: Matthew D
authors: MD
authors: Barber
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D013997:Time Factors; D014596:Uterine Prolapse / Q000601:surgery*