# Feasibility and Clinical Outcomes of Robot-Assisted Sacrocolpopexy Using Autologous Round Ligament Grafts: A Novel Non-Mesh Surgical Approach for Pelvic Organ Prolapse

## TL;DR

A new robot-assisted surgery using a patient's own tissue for pelvic organ prolapse shows promise as a non-mesh alternative with good short-term results.

## Contribution

First report of non-mesh robot-assisted sacrocolpopexy using autologous round ligament grafts.

## Key findings

- Non-mesh RSC using autologous round ligament grafts was feasible in all patients without intraoperative complications.
- Short-term outcomes showed 5% grade ≥2 complications and 8% POP recurrence, with symptomatic improvement in all patients.
- Higher BMI and advanced prolapse stage were significant predictors of recurrence.

## Abstract

Background and Objectives: To evaluate the feasibility and clinical outcomes of a novel non-mesh robot-assisted sacrocolpopexy (RSC) using autologous round ligament (ARL) grafts in patients with pelvic organ prolapse (POP). Materials and Methods: This retrospective study included 92 patients who underwent non-mesh RSC with ARL grafts at Kagoshima University Hospital between August 2020 and June 2024. All patients met the inclusion criteria for symptomatic POP-Q stage II or higher and elected to undergo non-mesh RSC. The procedures were performed using the da Vinci® Xi or the hinotori™ Surgical Robot System. The clinical characteristics, operative data, complications, and recurrence rates were analyzed. Results: ARL harvesting was feasible in all patients, and the non-mesh RSC procedure was completed without conversion to open surgery or any intraoperative complications. The median operative time was 251 min, and the median blood loss was 30 mL. Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in five patients (5%), all of whom developed pelvic infections. De novo stress urinary incontinence was observed in one patient (1%). POP recurrence occurred in seven patients (8%) during a median follow-up of 3 months (range, 3–18 months), all of whom presented with cystocele. Five patients underwent reoperation, and two were managed conservatively. All patients experienced postoperative symptomatic improvement. A higher BMI and advanced POP-Q stage were significant predictors of recurrence. Conclusions: This is the first report of non-mesh RSC using an ARL graft. The procedure is feasible and effective, avoids the use of synthetic mesh, and offers short-term outcomes comparable to those of mesh-based RSC. ARL-based RSC represents a promising alternative, especially for patients at risk of mesh-related complications. Long-term follow-up is required to confirm durability.