Tunneling Versus Dissection Technique During Robotics-Assisted Sacrocolpopexy: A Randomized Clinical Trial

Introduction and Hypothesis: The retroperitoneal tunneling technique during sacrocolpopexy (SCP) has been suggested as being associated with a shorter ope rative time, adhesion formation, and nerve injuries, but rigorous data on this technique are limited. Methods: A randomized, single-center trial of tunneling versus dissection technique for robotics-assisted (RA) SCP was conducted. Eligible participants had stage 2–4 POP and desired SCP. The primary outcome was operative time between two techniques. Secondary outcomes included POP-Q measurement, Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7), Decision Regret Scale (DRS), Patient Global Impression of Improvement (PGI-I), and Satisfaction with Decision Scale (SDS). Participants were followed up at 6 and 12 weeks postoperatively. Results: Among 39 participants, 20 (51.3%) were in the dissection group and 19 (48.7%) were in the tunneling group. The dissection group had a longer technique operative time (13.11 ± 2.96 min vs 9.06 ± 3 min; p < 0.0005). At 12 weeks’ follow-up, there was no significant difference in POP-Q measurements between groups (all p > 0.05). Quality-of-life measures including PFDI-20, PFIQ-7, SDS, DRS, and PGI-I are similar between groups (all p > 0.05). However, the dissection group had fewer prolapse symptoms than the tunneling group based on the subscale Pelvic Organ Prolapse Distress Inventory-6 (16.23 ± 12.41 vs 33.56 ± 15.82, p = 0.0379). Conclusions: During RA SCP, operative time is longer when using retroperitoneal dissection than when using the tunneling technique. However, both techniques offer comparable anatomical and quality-of-life outcomes in the short-term postoperative follow-up.