Meta-analysis Of Robotic-assisted Sacrocolpopexy And Laparoscopic Sacrocolpopexy For Pelvic Organ Prolapse

Objective: To systematically evaluate the efficacy of robotic-assisted sacro-colpopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse through evidence-based medical methods,and to provide a basis for clinical surgical decisions.Methods: Through computer retrieval PubMed,The Cochrane Library,EMbase,Web of science,Chinese knowledge network database,Chinese biomedical literature,wanfang medical database,weipu medical database and other databases were published on the treatment of pelvic organ prolapse by robotic-assisted sacrocolpopexy and laparoscopic sacrocolpopexy.The methods applied in these studies were randomized controlled trials,non-randomized controlled trials,prospective or retrospective case-control studies and cohort studies.The search period is from January 2004 to January 2020.The retrieval process does not restrictions the language category.The included studies were screened independently by the two researchers according to the inclusion exclusion criteria,Cochrane Reviewer's HANDbook 5.1.1 and Newcastle-Ottawa Scale(NOS),and the literature quality rating and relevant data were extracted for meta-analysis using Rev Man 5.3 software provided by the Cochrane collaboration.Results: A total of 13 articles were included,and a total of 2098 patients were collected,including 951 patients in the robotic-assisted sacrocolpopexy group and 1147 patients in the laparoscopic sacrocolpopexy group.Meta-analysis results suggest:(1)General situation: The previous hysterectomy in the robotic-assisted sacrocolpopexy group was significantly lower than that in the laparoscopic sacrocolpopexy group,and the difference was statistically significant(RR=0.85,95% CI: 0.74-0.96,P=0.01).However,there were no significant differences in age,body mass index,premenopausal period,previous pelvic organ prolapse repair,previous urinary incontinence repair,and preoperative pop-q grading of Aa,Ba,Ap,Bp and point C(P>0.05).(2)Surgery: The operation time in the robotic-assisted sacrocolpopexy group was significantly longer than that in the laparoscopic sacrocolpopexy group,and the difference was statistically significant(MD: 29.95 min,95%CI: 5.85-54.04 min,P=0.01).The intraoperative blood loss was significantly lower than that in the laparoscopic sacrocolpopexy group,and the difference was statistically significant(MD:-69.02 ml,95%CI:-129.03--9.02 ml,P=0.02).The rate of conversion to open surgery was significantly lower than that of the laparoscopic sacrocolpopexy group,and the difference was statistically significant(RR = 0.40,95% CI: 0.18-0.85,P = 0.02).There were no significant differences in blood transfusion rate,intra-operative hysterectomy,intra-operative pelvic floor repair,intra-operative other surgical rates,intra-operative complications,and length of hospital stay(P> 0.05).(3)Postoperative effect: The position of the Aa point of the POP-Q grading in the robotic-assisted sacrocolpopexy group was lower than that in the laparoscopic sacrocolpopexy group,and the difference was statistically significant(MD:0.16,95%CI:-0.01-0.30,P=0.03).Postoperative complications,recurrent prolapse,secondary surgery rate,mesh erosion rate,objective cure rate,postoperative pop-q grading of Ap,Ba,Bp,and C points were not significantly different(P> 0.05).Conclusion: Robotic-assisted sacrocolpopexy,as a new surgical method,and laparoscopic sacrocolpopexy are both effective in the treatment of pelvic organ prolapse.In addition to robotic sacral fixation,the operation time is longer than laparoscopic sacral fixation.The intraoperative blood loss and the rate of conversion to open surgery are lower than those of laparoscopic sacral fixation.Although both objective and subjective cure rates are higher.But the postoperative pop-q grading of Aa point recovery of the latter is better than the former.