title: Robotic versus laparoscopic sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Pelvic organ prolapse shows an increasing prevalence (3-50 %). The gold standard treatment for apical prolapse is sacrocolpopexy, which can be performed via minimal access (conventional laparoscopy or robotic surgery) or open sacrocolpopexy. The objective is to appraise the effectiveness and safety of robotic surgery compared with laparoscopic sacropexy in the treatment of apical prolapse.
  
  
  METHODS
  Keywords were searched in: CINAHL, MEDLINE, CENTRAL, Cochrane MDSG Trials Register, Cochrane Library, Current Controlled Trials, ClinicalTrials.gov, WHO International Trials Registry Platform search portal, LILACS, and Google Scholar. A hand-search was also performed from IUJ and JMIG. Randomised and non-randomised controlled trials evaluating all women who underwent robotic sacropexy (RSC) or laparoscopic sacropexy (LSC) were included. A data extraction tool was used for data collection. RSC was compared with LSC. Narrative analysis and meta-analysis (RevMan) were conducted where appropriate.
  
  
  RESULTS
  Nine papers compared RSC with LSC, involving 1,157 subjects. No significant difference was found between approaches for anatomical outcomes, mortality, hospital stay (MD: -0.72/95 % CI 1.72, 0.28], p = 0.16), and postoperative quality of life. However, robotic sacropexy had more postoperative pain and longer operating times, although fewer overall complications when performed concomitantly with hysterectomy (OR 0.35; 95 % CI 0.19-0.64).
  
  
  CONCLUSIONS
  Robotic sacropexy was related to more postoperative pain and longer operating times. However, no significant differences were found regarding anatomical outcomes, mortality, hospital stay or postoperative quality of life. Cautious interpretation of results is advised because of the risk of bias caused by the inclusion of non-randomised studies. More research comparing RSC with LSC is mandatory, particularly draw conclusions regarding estimated blood loss and complication rate.
authors.affiliation: Faculty of Medical Science, Anglia Ruskin University, Chelmsford, United Kingdom. Maribeldgds@yahoo.es.
authors.forename: Maribel
authors.initials: M
authors.lastname: De Gouveia De Sa
authors.affiliation: Faculty of Medical Science, Anglia Ruskin University, Chelmsford, United Kingdom.
authors.forename: Leica Sarah
authors.initials: LS
authors.lastname: Claydon
authors.affiliation: Faculty of Medical Science, Anglia Ruskin University, Chelmsford, United Kingdom.
authors.forename: Barry
authors.initials: B
authors.lastname: Whitlow
authors.affiliation: Pelvic Reconstructive Surgeon, Hospital Carlos J. Bello, Caracas, Venezuela.
authors.forename: Maria Angelica
authors.initials: MA
authors.lastname: Dolcet Artahona
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications; D012371:Robotics
keywords: Apical prolapse; Laparoscopy; Robotic surgery; Sacropexy