Medium Term Outcomes for Robotic Sacral Colpopexy With Autologous Fascia Lata

Abstract

OBJECTIVES: To evaluate the medium-term outcomes of robotic sacral colpopexy (RSC) using autologous fascia lata for the treatment of apical pelvic organ prolapse. METHODS: An IRB-approved retrospective review was conducted on patients who underwent RSC with autologous fascia lata at a single institution between November 2017 and August 2022. Only patients with a minimum of 24 months of follow-up were included as short-term results have already been published. Data collected included patient demographics, operative details, surgical complications, Pelvic Organ Prolapse Quantification (POP-Q) measurements, and patient-reported outcomes using the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). The primary outcome was the medium-term durability of autologous fascia lata RSC, with recurrence defined as > 0 cm from the hymen in any compartment on postoperative POP-Q examination or recurrence at the apex of ≥ 2 cm. RESULTS: Nineteen patients met the inclusion criteria, with a mean follow-up of 42.8 ± 11.9 months. All POP-Q values showed significant improvement postoperatively, with only one (6.3%) patient experiencing posterior compartment recurrence and one (6.3%) with exactly 2 cm of apical descent. One patient (5.2%) required surgical retreatment with posterior colporrhaphy and a pubovaginal sling. Patient-reported outcomes demonstrated significant improvement in UDI-6 and IIQ-7 scores (p < 0.05). Minor complications related to fascia lata harvest were observed, including seroma (10.5%), transient paresthesia (21%), hematoma (5.2%), and deep vein thrombosis (5.2%), with most resolving spontaneously. CONCLUSIONS: RSC with autologous fascia lata provides durable medium-term anatomic and symptomatic improvement for apical POP, with low recurrence and retreatment rates. While minor harvest-related complications were observed, most were self-limiting. These findings support the use of autologous fascia lata as a viable alternative to synthetic mesh in RSC. Larger, multicenter studies with extended follow-up are needed to further validate these results.