title: Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review.
abstract: The use of robot-assisted surgery (RAS) has gained popularity in the field of gynaecology, including pelvic floor surgery. To assess the benefits of RAS, we conducted a systematic review of randomized controlled trials comparing laparoscopic and robotic-assisted sacrocolpopexy. The Cochrane Library (1970-January 2015), MEDLINE (1966 to January 2015), and EMBASE (1974 to January 2015) were searched, as well as ClinicalTrials.gov and the International Clinical Trials Registry Platform. We identified two randomized trials (n= 78) comparing laparoscopic with robotic sacrocolpopexy. The Paraiso 2011 study showed that laparoscopic was faster than robotic sacrocolpopexy (199 ± 46 vs. 265 ± 50 min;p< .001), yet in the ACCESS trial, no difference was present (225 ± 62.3 vs. 246.5 ± 51.3 min;p= .110). Costs for using the robot were significantly higher in both studies, however, in the ACCESS trial, only when purchase and maintenance of the robot was included (LSC US$11,573 ± 3191 vs. RASC US$19,616 ± 3135;p< .001). In the Paraiso study, RASC was more expensive even without considering those costs (LSC US$ 14,342 ± 2941 vs. RASC 16,278 ± 3326;p= 0.008). Pain was reportedly higher after RASC, although at different time points after the operation. There were no differences in anatomical outcomes, pelvic floor function, and quality of life. The experience with RASC was tenfold lower than that with LSC in both studies. The heterogeneity between the two studies precluded a meta-analysis. Based on small randomized studies, with surgeons less experienced in RAS than in laparoscopic surgery, robotic surgery significantly increases the cost of a laparoscopic sacrocolpopexy. RASC would be more sustainable if its costs would be lower. Though RASC may have other benefits, such as reduction of the learning curve and increased ergonomics or dexterity, these remain to be demonstrated.
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium ; Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: Geertje
authors.initials: G
authors.lastname: Callewaert
authors.affiliation: Belgian Center for Evidence Based Medicine (CEBAM), Belgian Branch of the Cochrane Collaboration, 3000 Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Bosteels
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: Susanne
authors.initials: S
authors.lastname: Housmans
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium ; Department of Obstetrics and Gynaecology, Jessa Hospital, 3500 Hasselt, Belgium.
authors.forename: Jasper
authors.initials: J
authors.lastname: Verguts
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium ; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ben
authors.initials: B
authors.lastname: Van Cleynenbreugel
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium ; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Van der Aa
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium ; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium ; Department of Gynaecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium.
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, 3000 Leuven, Belgium ; Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
keywords: Costs; Laparoscopy; Pelvic organ prolapse; Robotics; Sacrocolpopexy; Vault prolapse