To define the surgical and patient-reported outcomes of robotic-assisted sacrocolpopexy using autologous rectus fascia graft (SCARF) for the treatment of apical vaginal prolapse

Design: Prospective observational study

Setting:

15 degrees Trendelenburg with 5 degrees left lateral tilt to harvest rectus fascia. 25 degrees Trendelenburg for sacrocolpopexy

Patients or Participants:

40 patients referred with advanced apical POP from April 2021 to April 2023. Median follow-up of 12 months.

Interventions:

Robotic-assisted SCARF or supracervical hysterectomy with sacro-cervicopexy (SCCARF) using a posterior rectus sheath graft harvested and fashioned during the same procedure

Measurements and Main Results:

POP-Q scores were assessed pre-operatively and at 3 and 6 months post-operatively. Subjects’ quality of life, bladder, bowel and sexual function were recorded using Pelvic Floor Disability Index (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and Patient Global Impression of Improvement (PGI) survey. 52% of patients had SCARF and 48% had supracervical hysterectomy with SCCARF. 45% had previous prolapse surgery. The average operating time for SCARF was 101 mins (range 70 -180 mins) and for SCCARF was 105 mins (range 74- 140). The average time to harvest graft was 12 mins (range 7.5 – 19 mins).

There were no blood transfusions, re-operations, adverse surgical outcomes or prolapse recurrence. The average hospital stay was 1.15 days.

POP-Q stage improved from 3.225 to 0.1, p<0.0005.

PFDI-20 improved from 141.8 to 14.66, p<0.0005. PISQ12 showed statistically significant improvement in all sexual function, urinary and faecal continence measures, and PISQ Total Score improved from 31.03 to 17.30, p<0.0005. PGI-I scores were high, showing high levels of satisfaction.

Conclusion:

This is the first report of patients with apical POP managed with autologous rectus fascia for sacrocolpopexy/sacrocervicopexy performed robotically. This procedure produces acceptable anatomical and patient-reported outcomes whilst avoiding mesh-related complications. Larger study size and long-term follow up are needed to establish rectus fascia as a standard graft material for sacrocolpopexy.