{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:35:35Z","timestamp":1792794935243,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: POP (pelvic organ prolapse) involves the descent of one or more pelvic organs downwards with or without protrusion from the vaginal opening, caused by the relaxation and weakening of ligaments, connective tissue, and pelvic muscles. Such an outcome negatively impacts the quality of life. The gold standard procedure for repairing apical compartment prolapse is colposacropexy (CS) to secure the anterior and posterior walls of the vagina to the anterior longitudinal sacral ligament, located anteriorly to the sacral promontory, using a mesh. Several surgical approaches are feasible. Laparotomic or minimally invasive methods, including laparoscopic or robotic ones, can restore the horizontal axis of the vagina and typically involve concomitant hysterectomy. Methods: This study is based on 80 patients who underwent CS at Palermo\u2019s Ospedali Riuniti Villa Sofia-Cervello from 2019 to 2023. Women aged 35\u201385 at the time of surgery were divided into two groups: 40 patients underwent mini-laparoscopic surgery, and 40 patients underwent robotic surgery. The following parameters were accounted for: demographic data (initials of name and surname, age), preoperative clinical diagnosis, date of surgery, surgical procedure performed, estimated intraoperative blood loss, duration of surgical intervention, length of hospital stay, postoperative pain assessed at 24 h using the VAS scale, and any complications occurring in the postoperative period. Mini-laparoscopic CS (Minilap) and robotic CS (Rob) were then compared in terms of outcomes. Results: In the Minilap group, 11 patients out of 40 had a preoperative diagnosis of vaginal vault prolapse. The average age in this group was 61.6. Five of these patients had isolated cystocele, while the rest presented vaginal stump prolapse linked to cystocele, rectocele, or both. The remaining 29 patients in the Minilap group had a preoperative diagnosis of uterovaginal prolapse, also associated with cystocele, rectocele, or both, or isolated in nine cases. In the Rob group (average age: 60.1), 13 patients were diagnosed with vaginal prolapse (isolated or associated with cystocele), while the remaining 27 had a diagnosis of uterovaginal prolapse. In the Minilap group, the average procedure duration was 123.3 min, shorter than the Rob group (160.1 min). Conclusions: The data collected throughout this prospective study point to the mini-laparoscopic approach as being preferable over the robotic one in terms of surgical procedure length, intraoperative blood loss, postoperative pain, and aesthetic outcome. Hospital stay duration and post operative complication rates were similar for both groups. The innovative and ever-progressing nature of such procedures calls for novel standards prioritizing patient care as well as medicolegal viability.<\/jats:p>","DOI":"10.3390\/jcm13164802","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T03:49:36Z","timestamp":1723693776000},"page":"4802","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Robotic versus Mini-Laparoscopic Colposacropexy to Treat Pelvic Organ Prolapse: A Retrospective Observational Cohort Study and a Medicolegal Perspective"],"prefix":"10.3390","volume":"13","author":[{"given":"Valentina","family":"Billone","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4269-4269","authenticated-orcid":false,"given":"Giuseppe","family":"Gullo","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girolamo","family":"Perino","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Catania","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaspare","family":"Cucinella","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ganduscio","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology Unit, AOOR Villa Sofia Cervello Hospital, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Vassiliadis","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5741-7139","authenticated-orcid":false,"given":"Simona","family":"Zaami","sequence":"additional","affiliation":[{"name":"Department of Anatomical, Histological, Forensic and Orthopedic Sciences, \u201cSapienza\u201d University of Rome, 90133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"441.e1","DOI":"10.1016\/j.ajog.2010.12.024","article-title":"Body Image Perceptions in Women with Pelvic Organ Prolapse: A Qualitative Study","volume":"204","author":"Lowder","year":"2011","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1097\/00003081-199312000-00015","article-title":"Anatomy and Biomechanics of Genital Prolapse","volume":"36","author":"DeLancey","year":"1993","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"469","DOI":"10.5114\/wiitm.2019.88749","article-title":"Laparoscopic Approach to Pelvic Organ Prolapse\u2014The Way to Go or a Blind Alley?","volume":"14","author":"Malanowska","year":"2019","journal-title":"Videosurg. Other Miniinvasive Tech."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e0017","DOI":"10.5041\/RMMJ.10294","article-title":"Surgical Updates in the Treatment of Pelvic Organ Prolapse","volume":"8","author":"Kenton","year":"2017","journal-title":"Rambam Maimonides Med. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1097\/AOG.0b013e3181c2ce96","article-title":"Forecasting the Prevalence of Pelvic Floor Disorders in U.S. Women: 2010 to 2050","volume":"114","author":"Wu","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_6","first-page":"232","article-title":"Robot-Assisted Laparoscopic Colposacropexy and Cervicosacropexy with the Da Vinci\u00ae Surgical System","volume":"20","author":"Matthews","year":"2010","journal-title":"Surg. Technol. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1007\/s00192-017-3296-5","article-title":"Laparoscopic Sacrocolpopexy Compared with Open Abdominal Sacrocolpopexy for Vault Prolapse Repair: A Randomised Controlled Trial","volume":"28","author":"Coolen","year":"2017","journal-title":"Int. Urogynecol. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/j.1471-0528.2005.00646.x","article-title":"Long Term Review of Laparoscopic Sacrocolpopexy","volume":"112","author":"Higgs","year":"2005","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1097\/AOG.0b013e31818ce394","article-title":"Short-Term Outcomes of Robotic Sacrocolpopexy Compared with Abdominal Sacrocolpopexy","volume":"112","author":"Geller","year":"2008","journal-title":"Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00192-008-0768-7","article-title":"A Comparison of Laparoscopic and Abdominal Sacral Colpopexy: Objective Outcome and Perioperative Differences","volume":"20","author":"Klauschie","year":"2009","journal-title":"Int. Urogynecol. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00192-015-2765-y","article-title":"Laparoscopic versus Open Sacrocolpopexy for Treatment of Prolapse of the Apical Segment of the Vagina: A Systematic Review and Meta-Analysis","volume":"27","author":"Claydon","year":"2016","journal-title":"Int. Urogynecol. J."},{"key":"ref_12","first-page":"365","article-title":"Operations of support-suspension by upper route in the treatment of vaginal prolapse","volume":"3","author":"Scali","year":"1974","journal-title":"J. Gynecol. Obstet. Biol. Reprod."},{"key":"ref_13","first-page":"CD004014","article-title":"Surgical Management of Pelvic Organ Prolapse in Women","volume":"4","author":"Maher","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1089\/gyn.1992.8.111","article-title":"Operative Laparoscopy (Minimally Invasive Surgery): State of the Art","volume":"8","author":"Nezhat","year":"1992","journal-title":"J. Gynecol. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1111\/j.1464-410X.2007.07109.x","article-title":"Robotic Abdominal Sacrocolpopexy\/Sacrouteropexy Repair of Advanced Female Pelvic Organ Prolaspe (POP): Utilizing POP-Quantification-Based Staging and Outcomes","volume":"100","author":"Daneshgari","year":"2007","journal-title":"BJU Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.juro.2006.03.040","article-title":"Long-Term Results of Robotic Assisted Laparoscopic Sacrocolpopexy for the Treatment of High Grade Vaginal Vault Prolapse","volume":"176","author":"Elliott","year":"2006","journal-title":"J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"331","DOI":"10.5152\/tud.2019.19068","article-title":"The Current State and the Future of Robotic Surgery in Female Pelvic Medicine and Reconstructive Surgery","volume":"45","author":"Sussman","year":"2019","journal-title":"Turk. J. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Xiao, P., Li, L., Qu, J., and Wang, G. (2024). Global Research Hotspots and Trends on Robotic Surgery in Obstetrics and Gynecology: A Bibliometric Analysis Based on VOSviewer. Front. Surg., 11.","DOI":"10.3389\/fsurg.2024.1308489"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00345-011-0748-2","article-title":"Prospective Comparison of Short-Term Functional Outcomes Obtained after Pure Laparoscopic and Robot-Assisted Laparoscopic Sacrocolpopexy","volume":"30","author":"Seror","year":"2012","journal-title":"World J. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1097\/AOG.0b013e318231537c","article-title":"Laparoscopic Compared with Robotic Sacrocolpopexy for Vaginal Prolapse: A Randomized Controlled Trial","volume":"118","author":"Paraiso","year":"2011","journal-title":"Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1016\/j.purol.2014.09.045","article-title":"Comparison of Functional Outcomes with Purely Laparoscopic Sacrocolpopexy and Robot-Assisted Sacrocolpopexy in Obese Women","volume":"24","author":"Joubert","year":"2014","journal-title":"Prog. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S0090-4295(02)01717-X","article-title":"Comparison of Robotic versus Laparoscopic Skills: Is There a Difference in the Learning Curve?","volume":"60","author":"Yohannes","year":"2002","journal-title":"Urology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.surg.2009.11.002","article-title":"A Comparison of Laparoscopic and Robotic Assisted Suturing Performance by Experts and Novices","volume":"147","author":"Chandra","year":"2010","journal-title":"Surgery"},{"key":"ref_24","unstructured":"The National Women and Infants Health Programme (NWIHP) and the Institute of Obstetricians and Gynaecologists (IOG) Clinical Advisory Group (CAG) (2024, June 24). National Clinical Practice Guideline Diagnosis and Management of Pelvic Organ Prolapse. Available online: https:\/\/www.hse.ie\/eng\/about\/who\/acute-hospitals-division\/woman-infants\/clinical-guidelines\/diagnosis-and-management-of-pelvic-organ-prolapse.pdf."},{"key":"ref_25","unstructured":"Aboseif, C., and Liu, P. (2024). Pelvic Organ Prolapse. StatPearls, StatPearls Publishing."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/jocn.13408","article-title":"Vaginal Pessaries: Can an Educational Brochure Help Patients to Better Understand Their Care?","volume":"26","author":"Murray","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1016\/S0002-9378(96)70091-1","article-title":"Interobserver and Intraobserver Reliability of the Proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society Pelvic Organ Prolapse Classification System","volume":"175","author":"Hall","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.1002\/nau.23740","article-title":"How to Use the Pelvic Organ Prolapse Quantification (POP-Q) System?","volume":"37","author":"Madhu","year":"2018","journal-title":"Neurourol. Urodyn."},{"key":"ref_29","unstructured":"National Institute for Health and Care Excellence (2024, June 24). Urinary Incontinence and Pelvic Organ Prolapse in Women: Management. NICE Guideline [NG123]. Available online: https:\/\/www.nice.org.uk\/guidance\/ng123\/resources\/urinary-incontinence-and-pelvic-organ-prolapse-in-women-management-pdf-66141657205189."},{"key":"ref_30","unstructured":"Davey, M. (2024, June 24). Johnson & Johnson Reaches $300 m Settlement over Pelvic Mesh Implants. Issued on 12 September 2022. Available online: https:\/\/www.theguardian.com\/business\/2022\/sep\/12\/johnson-johnson-reaches-300m-settlement-over-pelvic-mesh-implants."},{"key":"ref_31","unstructured":"Miller, R.V. (2024, June 24). Vaginal Mesh Lawsuits in 2024. Available online: https:\/\/www.lawsuit-information-center.com\/vaginal-mesh-lawsuits-in-2024.html."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Jamjoom, A.A.B., Jamjoom, A.M.A., Thomas, J.P., Palmisciano, P., Kerr, K., Collins, J.W., Vayena, E., Stoyanov, D., Marcus, H.J., and iRobotSurgeon Collaboration (2022). Autonomous Surgical Robotic Systems and the Liability Dilemma. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1015367"},{"key":"ref_33","first-page":"e43634","article-title":"In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery","volume":"15","author":"Pai","year":"2023","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Medenica, S., Zivanovic, D., Batkoska, L., Marinelli, S., Basile, G., Perino, A., Cucinella, G., Gullo, G., and Zaami, S. (2022). The Future Is Coming: Artificial Intelligence in the Treatment of Infertility Could Improve Assisted Reproduction Outcomes-The Value of Regulatory Frameworks. Diagnostics, 12.","DOI":"10.3390\/diagnostics12122979"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jss.2020.03.046","article-title":"Intelligent, Autonomous Machines in Surgery","volume":"253","author":"Loftus","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e1968","DOI":"10.1002\/rcs.1968","article-title":"Legal, Regulatory, and Ethical Frameworks for Development of Standards in Artificial Intelligence (AI) and Autonomous Robotic Surgery","volume":"15","author":"Nevejans","year":"2019","journal-title":"Int. J. Med. Robot."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4802\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:36:51Z","timestamp":1760110611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,15]]},"references-count":36,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164802"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164802","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,15]]}}}