INTRODUCTION: Minimally invasive sacrocolpopexy (MISC) is the most durable apical prolapse surgery, with both robotic (RSC) and laparoscopic (LSC) techniques showing favorable outcomes. Early randomized trials found longer operative times with RSC. We hypothesize that with surgical evolution, RSC operative time is now shorter. OBJECTIVE: To evaluate the relationship between MISC surgical approach (RSC vs LSC) and operative time using a national database. METHODS: A retrospective cohort analysis was conducted using the 2022 and 2023 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Gynecology Participant Use File. Patients undergoing MISC were identified with CPT code 57425 and divided into RSC and LSC cohorts. Primary objective was to assess the impact of MISC surgical approach on operative time. Differences in patient demographics, clinical characteristics, and perioperative outcomes were analyzed as secondary objectives. Standard group comparisons were performed using the Mann–Whitney U test for continuous variables and chi-square test for categorical variables. A multivariable logistic regression was performed to determine if operative time is impacted by surgical approach after controlling for potential confounding variables. Backward selection was used to identify variables and variables with a p<0.10 on bivariate analysis were included. RESULTS: A total of 2,367 patients underwent MISC: 1,917 (80.9%) RSC and 450 (19.1%) LSC (Table 1). Median (range) age was 63 years (52–70), and BMI was 28.0 kg/m2 (24.9–31.8) for the cohort. Majority of women were White (74.7%) with American Society of Anesthesiologists (ASA) functional class 2 (69.8%). Concomitant hysterectomy and incontinence surgery were performed in 44.1% and 34.8%, respectively. Additional prolapse surgery was performed during 33.3% of MISC. Obstetricians and gynecologists (OBG) performed 78.4% surgeries, and urologists (URO) performed 20.5%. Median operative time was 157 minutes (113–217), and length of stay was 1 day (0–1). Overall, the 30-day postoperative complication rate was 5.4%. When comparing surgical approaches, women in the MISC-RSC cohort were more likely to be older (63 years vs 61, p=0.02) with White race (77.4% vs 63.1%, p<0.001). Majority of MISC-LSC and MISC-RSC were performed by OBG surgeons (92.7% and 75.1%, respectively). However, a greater proportion of URO surgeons utilized MISC-RSC compared to MISC-LSC (24.0% vs 7.1%). Median operative time was longer with MISC-LSC compared to MISC-RSC (173 minutes vs 155, p<0.001). Median length of stay was longer after MISC-RSC (1 day vs 0, p=0.02). On backward linear regression, LSC surgical approach was associated with longer operative time compared to RSC (95% CI 1.04–1.22, p=0.004) after controlling for age, race, ASA class, concomitant incontinence surgery, and surgeon specialty (Table 2). URO surgeon specialty was also associated with longer MISC operative time compared to OBG (95% CI 1.02–1.21, p=0.02). CONCLUSIONS: MISC-RSC had an 18-minute shorter operative time compared to MISC-LSC. Operative time remained significantly different between RSC and LSC after controlling for potential confounding variables.Table 1Table 2
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