Robotic-Assisted Laparoscopic Sacrocolpopexy: Temporary Phenomenon or a New Consolidated Technique

ration of normal anatomy, retain the axis and depth of the vagina thus preserving sexual function, and provide a lasting result in time. Unfortunately, these are difficult goals to achieve with one specific technique. The first comparison series between ACSP and LCSP was published by Parai so et al. [6] who described the advantages and disadvantages. The advantages of the LCSP include a shorter hospital stay, less postoperative pain and less bleeding. The disadvantages are a longer learning curve and increased operative time. In selected cases, the disadvantages become an investment to obtain good results by minimally invasive surgery. We were struck by the meta-analysis of 1,000 patients published by Gamatra et al. [7] in European Urology in 2009. It describes quite comparable results between ACSP and LCSP, suggesting the need for minimally invasive techniques to undermine the ACSP. The continuous development and advances in medicine and the application of new technologies have allowed the introduction of robotics as a tool for surgeons. In this sense, the first robotic urological procedure approved by the FDA was radical prostatectomy, and robotic colposacropexy was approved in April 2005. Robotic colposacropexy was used for the first time The best approach to the restoration of the vagina remains controversial. Historically, vaginal and abdominal approaches have been used in the treatment of pelvic organ prolapse (POP). The vaginal vault support above the sacrum, using synthetic material is a durable technique and preserves the axis and depth of the vagina. This allows patients to maintain normal sexual activity [1–5] . What still seems uncertain is whether this method will be comparable to other minimally invasive transvaginal approaches, but the absence of published studies causes a lack in the knowledge. Supporting the existing literature [2– 5] , we highlight the following considerations so they can be applied in clinical practice: (1) In vaginal vault prolapse, the abdominal colposacropexy (ACSP) provides a lower rate of recurrence and dyspareunia compared with sacrospinous colpopexy. (2) In apical prolapse, ACSP has a success rate ranging from 78 to 100%. This makes it a ‘gold standard’ technique. (3) Laparoscopic colposacropexy (LCSP) provides a shorter convalescence and less morbidity than ACSP, but at the expense of a longer learning curve. Before proceeding, we must consider what goals we want to achieve with surgery for pelvic organ prolapse. In this sense, we believe that surgery should improve the symptoms of prolapse, appropriate restoReceived: August 25, 2011 Accepted: September 13, 2011 Published online: January 11, 2012