Abdominal versus robotic sacral colpopexy: A detailed analysis of outcomes

A Cohort Study Comparing Cost-Efficiency of Abdominal and Robotic Sacrocolpopexy

OBJECTIVE

To compare cost and reimbursement of robotic and abdominal sacrocolpopexy procedures to evaluate which approach may minimize costs while improving the hospital profit margin.

METHODS

We performed an IRB-exempt retrospective cohort study investigating all patients who underwent robotic or abdominal sacrocolpopexy at our hospital between July 1, 2018 and May 31, 2022. Patient demographic, procedural, and postoperative course data were extracted via chart review including duration of procedure, time in operating room, complications, and length of hospital stay. The billing department provided information on estimated cost of stay and reimbursement rates.

RESULTS

A total of 203 robotic and 291 abdominal cases were included in analysis. The groups had significant differences in demographics, including race and insurance status. Abdominal procedures were associated with lower costs ($7675.99 vs 8747.48, P <.0001) and higher reimbursement rates ($ 16,210.48 vs $ 10,102.28, P <.0001), with the total collected (reimbursement minus cost), or profit margin, differing significantly ($8534.50 vs $1354.80, P <.0001). Discrepancies in reimbursement and profit remained after controlling for secondary procedures. Abdominal cases also had shorter average duration (129.9 vs 168.4 minutes, P <.0001). Abdominal sacrocolpopexy was associated with higher estimated blood loss (109.2 vs 97.9, P <.0001) and longer hospital stay (26.3 vs 15.9 hours, P <.0001).

CONCLUSION

Despite longer hospital stays and slightly higher estimated blood loss, abdominal sacrocolpopexy appears to have lower costs and higher reimbursement rates than robotic sacrocolpopexy, with a higher profit margin for the hospital.

Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy

Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.

Robot-assisted sacrohysteropexy vs robot-assisted sacrocolpopexy in women with primary advanced apical prolapse: A retrospective cohort study

BACKGROUND

This study aimed to evaluate the anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) against robot-assisted sacrocolpopexy (RASC) for the treatment of primary advanced apical prolapse.

METHODS

We conducted a retrospective cohort study of all robot-assisted pelvic organ prolapse surgeries for primary advanced apical prolapse (stage ≥II) between January 2011 and May 2021 at an academic tertiary hospital. Surgical outcomes and pelvic organ function were evaluated using the Pelvic Organ Prolapse Quantitative (POP-Q) stage and validated questionnaires (POPDI-6) during preoperative and postoperative 12-month follow-up evaluations. All data were obtained from electronic medical records.

RESULTS

A total of 2368 women underwent surgery for apical prolapse repair, and 18 women underwent either RASH (n = 11) or RASC (n = 7). Compared to the RASC group, the RASH group was significantly younger, premenopausal, and less parous. Preoperative prolapse stage, operative time, estimated blood loss, and hospitalization length was comparable between the groups. No intraoperative complications were observed. All women had a median follow-up duration of 24 months (range: 12-108 months). During the 12-month follow-up period, women in the RASH group reported higher satisfaction with the surgery than those in the RASC group (100% vs. 71.4%, p = 0.137). The mesh exposure rate was significantly higher in the RASC group (3/7, 42.9%) than in the RASH group (0/11, 0%) ( p = 0.043), which was found at 12 to 36 months postoperatively and was successfully managed with vaginal estrogen cream. In the RASH group, one woman required reoperation with anterior colporrhaphy for recurrent anterior prolapse at 60 months postoperatively. The apical success rate was 100% at one year postoperatively, without apical recurrence in either group during the follow-up period.

CONCLUSION

RASH represents an effective and feasible option for the surgical treatment of advanced primary apical prolapse in women who desire uterine preservation and have a significantly lower risk of mesh erosion than RASC.