(Poster 39) Retroperitoneal Tunneling vs Dissection During Robotic Sacrocolpopexy: A RCT

Objectives: To assess whether the tunneling technique during robotic assisted (RA) SCP is associated with shorter technique operative time as compared to the traditional retroperitoneal dissection technique.

Methods: A randomized, single-center trial of tunneling versus dissection technique for RA SCP was conducted. Eligible participants had stage 2-4 POP and desire SCP. Block randomization was utilized. Concomitant procedures were at the discretion of the primary surgeon. The primary outcome was operative time between two techniques. Secondary outcomes included POP-Q measurement, Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), Decision Regret Scale (DRS), Patient Global Impression of Improvement (PGI-I), and Satisfaction with Decision Scale (SDS). Patients were followed up at 6 and 12 weeks postoperatively.

Results: Among 39 participants, 20 (51.3%) were in dissection group and 19 (48.7%) in the tunneling group (Figure 1). Groups were similar in age, race, ethnicity, marital status, BMI, parity, menopausal status, prior POP and SUI surgery, except for history of Cesarean delivery (Figure 2). The tunneling group had shorter technique operative time 9.063 min vs. 13.112.96 min (P < 0.0005) (Table 1). Both groups showed the improvement in POP-Q measurements (Ba, Bp, C, Tvl) at 12 weeks with no difference between tunneling and dissection groups (all P>0.05). There were no differences in quality-of-life measures including PFDI-20, PFIQ-7, SDS, DRS, and PGI-I between two groups at 12 weeks (all P>0.05) (Table 2). However, the dissection group had less prolapse symptoms than the tunneling group at 12 weeks based on the subscale POPDI-6 (16.2312.41 vs 33.5615.82, P=0.0379).

Conclusions: The tunneling technique has shorter operative time than the traditional retroperitoneal dissection during RA SCP. However, both techniques offer comparable anatomical and quality of life outcomes in the short-term postoperative follow up.