EP807 - Evaluating Postoperative Morbidity of Robotic Sacrocolpopexy and Rectopexy versus Laparoscopic Surgery for Pelvic Organ Prolapse

Monday, May 12, 2025

1:31 PM – 1:36 PM PT

ePoster Presenter(s)

Randilu Amarasinghe (she/her/hers)

Medical Student
George Washington University School of Medicine and Health Sciences
Washington DC, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

JZ

Jacob Zarkower, MPH

Medical Student
George Washington School of Medicine and Health Sciences
Washington, District of Columbia, United States

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HA

Hannah M. Adams, BS MPH

Medical Student
University of Connecticut School of Medicine
FARMINGTON, Connecticut, United States

Disclosure information not submitted.
Christina Schott, n/a (she/her/hers)

Medical Student
George Washington University School of Medicine and Health Sciences
George Washington University School of Medicine and Health Sciences
Washington, District of Columbia, United States

Disclosure information not submitted.
HS

Hannaka Spillman, MA

Medical Student
George Washington School of Medicine and Health Sciences
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Meagan K. Mitchell (she/her/hers)

Medical Student
George Washington Univeristy School of Medicine and Health Sciences
Washington, DC, United States

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Gustavo R. Rodriguez, MD (he/him/his)

Resident Physician
The George Washington University
Washington, District of Columbia, United States

Disclosure information not submitted.
MK

Marian Khalili, MD

Assistant Professor
MFA
Washington, District of Columbia, United States

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Senior Author(s)

MN

Matthew Ng, MD

Assistant Professor of Surgery
Fellow
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Randilu Amarasinghe: This individual has no financial relationships with ineligible companies.

Jacob Zarkower, MPH: This individual has no financial relationships with ineligible companies.

Hannaka Spillman, MA: This individual has no financial relationships with ineligible companies.

Meagan K. Mitchell: This individual has no financial relationships with ineligible companies.

Marian Khalili, MD: This individual has no financial relationships with ineligible companies.

Matthew Ng, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: Pelvic organ prolapse occurs due to increased laxity of the pelvic floor connective tissue and muscles. This type of prolapse manifests most commonly after childbirth but can also be attributed to rigorous heavy lifting, gynecologic surgery, connective tissue abnormalities, hormonal imbalances, advanced age, and other factors. Symptoms of pelvic organ prolapse include difficulty with urination and defecation, urinary incontinence, fecal incontinence, and sexual dysfunction, which can significantly decrease patients’ quality of life. Surgical treatment options for pelvic organ prolapse include sacrocolpopexy and rectopexy, or a combination of both, however there is no clear evidence demonstrating a superior approach to performing these procedures.

Methods/Interventions: Data from the American College of Surgeons National Surgical Quality Improvement Program in 2022 was used to evaluate adult patients with pelvic organ prolapse treated with sacrocolpopexy and/or rectopexy. Chi square analysis and T tests were used to identify potential covariables associated with surgical approach including age, race, history of diabetes mellitus, smoking history, and preoperative hypoalbuminemia defined as less than 3.5mg/dL. Univariable and multivariable logistic regression was performed to compare postoperative morbidity and surgical approach (open, laparoscopic and robotic). Analyses were adjusted for covariables with statistically significant associations with surgical approach identified during univariable testing. Patients with ascites, disseminated cancer, and ventilator dependence were excluded.

Results/Outcomes: Among 1,965 patients, 1,765 patients received minimally invasive surgery (MIS). On average, these patients were younger, more likely to have diabetes, and less likely to have a history of smoking. Analyses were adjusted for race, age, history of diabetes and history of smoking. The analysis showed decreased likelihood of unplanned reoperation (OR 0.32, 95% CI 0.11-0.93) and superficial surgical site infection (SSI) (OR 0.24, 95% CI 0.09-0.65), and decreased length of stay by 1.3 days (95% CI 1.0-1.6) for MIS (laparoscopic or robotic) compared to open surgery.

Among 1,765 patients who received MIS, 1,403 received robotic surgery. Of 103 Black or African American patients, 78 (76%) received robotic surgery compared to 30 out of 42 (71%) Asian patients and 1073 out of 1291 (83%) white patients (p=0.03). Analyses were adjusted for race and hypoalbuminemia. The analysis showed decreased likelihood of organ space (SSI) (OR 0.39, 95% CI 0.09-1.67), UTI (OR 0.68, 95% CI 0.31-1.46), and sepsis (OR 0.37, 95% CI 0.09-1.55) compared to laparoscopic surgery, however, these findings were not statistically significant. There was no statistically significant difference in incidence of DVT, unplanned intubation, pneumonia, deep SSI, pulmonary embolism, and unplanned return to the operating room, or length of stay based on surgical approach.

Conclusion/Discussion: MIS for pelvic organ prolapse reduces postoperative morbidity and length of stay compared to open surgery. Racial disparities in pelvic organ prolapse treatment may exist as more white patients underwent robotic surgery compared to Black and Asian patients. Our findings also demonstrate a potential reduction in post-operative morbidity with robotic surgery compared to the laparoscopic approach. Additional research with larger population size is needed to further elucidate the benefits of robotic surgery for the treatment of pelvic organ prolapse.