Subjective and Objective Outcomes of Robotic and Vaginal High Uterosacral Ligament Suspension

Objectives: This study was designed to assess the short-term outcomes in patients undergoing robotic or transvaginal high uterosacral ligament suspension for symptomatic apical prolapse at the time of hysterectomy. Methods: This retrospective study used hospital and office electronic medical records to identify patients with symptomatic stage 2 to 4 prolapse, who had undergone either a robotic or transvaginal high uterosacral ligament suspension from July 2010 to January 2014. The database was searched using procedural codes for uterosacral ligament suspension. Each patient was contacted 1 year postoperatively to answer the pelvic floor distress inventory-20 via telephone, and this was compared to their initial pre-procedural baseline questionnaire. Results: Our primary outcome included the fulfillment of 3 criteria: (1) Prolapse leading edge of 0 or less and apex of 1/2 total vaginal length or less; (2) the absence of pelvic organ prolapse symptoms as reported on the pelvic floor distress inventory-20 question No. 3; and (3) no prolapse reoperations or pessary use during the study period. Ninety-two percent (24/26) in the robotic group and 85% (36/42) in the vaginal group (P = 0.46) successfully fulfilled these outcome criteria. There was no significant difference in the operative data between the 2 groups. There were no intraoperative complications in either group. Conclusions: These short-term outcomes are promising and show a high success rate for the uterosacral ligament suspension at the time of a hysterectomy regardless of whether it was performed vaginally or robotically.