Initial Experience with Robotic Retropubic Urethropexy Compared to Open Retropubic Urethropexy

Study Objective. To compare the clinical outcomes of robotic retropubic urethropexy versus open retropubic urethropexy. Design. Retrospective case-control study (II-2). Setting. University Hospital. Patients. All patients who underwent robotic retropubic urethropexy from 1/1/12 to 6/1/12 by a single gynecologic surgeon were included in the case series. The control cases consisted of the last five consecutive open retropubic urethropexies performed by the same surgeon. Main Results. A total of 10 patients (5 robotic cases and 5 open cases) were included in this study. Both groups were similar with respect to age, BMI, and obstetrical history. Mean hospital stay length and mean EBL were overall less for robotic cases than for open cases (1.2 days versus 2.6 days; 169？mL versus 300？mL). One of the 5 patients who underwent the open approach and 2 of the 5 patients who underwent the robotic approach sustained a minor intraoperative complication. All but one patient from each group experienced resolution of incontinence after the procedure. Two of the patients who underwent the open approach had postoperative complications. Conclusions. Robotic retropubic urethropexy may be a feasible alternative to open retropubic urethropexy. A larger study is necessary to support our observations. 1. Introduction Minimally invasive surgery has gained tremendous popularity over the recent decades. This popularity is due to several advantages associated with robotic surgery versus laparotomy, which include magnification resulting in better visualization, decreased blood loss and need for blood transfusions, shorter hospital stay and postoperative recovery, decreased postoperative pain, and decreased risk of infections [1–6]. Even more recently, robotic surgery has gained popularity due to improved precision and surgeon comfort when compared to laparoscopy. As experience and comfort with robotic surgery have increased, the robot is being used now for more comples surgeries, including urogynecologic procedures such as the retropubic urethropexies (i.e., Burch colposuspensions). Pelvic organ prolapse (POP) is becoming a more prominent problem, especially given the aging US population. The estimated lifetime risk of surgery for stress urinary incontinence or POP is 11%; however, this is likely an underestimate of the general population as it is based on hospital data [6]. The current literature surprisingly lacks information on experiences with robotic retropubic urethropexy in comparison to retropubic urethropexy associated with laparotomy (i.e., open retropubic urethropexy).