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

Sep 29, 2026

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Background: This retrospective cohort study evaluates anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) versus robot-assisted sacrocolpopexy (RASC) for primary advanced apical prolapse. Methods: Data from all robot-assisted pelvic organ prolapse surgeries (stage ≥ II) from January 2011 to May 2021 were analyzed at a tertiary academic hospital. Outcomes used POP-Q staging and POPDI-6 with 12-month follow-up, plus 24-month median follow-up. Results: No intraoperative complications occurred; mesh exposure was higher with RASC. Conclusion: RASH is effective and feasible, offering uterine preservation with lower mesh erosion risk.

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. J Chin MedAssoc Original article Robot-assisted sacrohysteropexy vs robotassisted sacrocolpopexy in women with primary advanced apical prolapse: A retrospective cohort study I-San Chana,b, Guan-Yeu Chena,b, Ying-Chu Shiha,b, Ling-Yu Jianga,b,c,d, Yen-Hou Changa,b,c,d, Tzu-Ya Wanga,b, Yi-Jen Chena,b,c,d,* aDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bDepartment of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; dInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract 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. Keywords: Apical prolapse; Pelvic organ prolapse; Robotic; Sacrohysteropexy; Sacrocolpopexy 1. INTRODUCTION Pelvic organ prolapse (POP) is a common condition.1 The prevalence of POP increases with life expectancy.2 More than 10 000 *Address correspondence. Dr. Yi-Jen Chen, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: chenyj@vghtpe.gov.tw](ROC. E-mail address: chenyj@vghtpe.gov.tw); chenyj@nycu. [edu.tw](edu.tw) (Y.-J. Chen). Conflicts of interest: Dr Yi-Jen Chen, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 418-425. Received August 16, 2022; accepted December 2, 2022. doi: 10. 1097/JCMA.0000000000000882. Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license

FAQs

What is the main purpose of comparing RASH and RASC in this study?

To evaluate the anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) versus robot-assisted sacrocolpopexy (RASC) for primary advanced apical prolapse.

How was the study designed and what data were used?

A retrospective cohort study analyzed all robot-assisted pelvic organ prolapse surgeries for primary advanced apical prolapse (stage ≥ II) between January 2011 and May 2021, using electronic medical records.

What were the key differences in safety outcomes between the two procedures?

No intraoperative complications were observed in either group, and mesh exposure was significantly higher in the RASC group than in the RASH group, with management using vaginal estrogen cream.

Sep 29, 2026

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