Laparoscopic Versus Robot-Assisted Sacrocolpopexy: A Systematic Review and Meta-Analysis

Objective: To compare the efficacy, safety and perioperative outcomes of robotic-assisted sacrocolpopexy (RASC) versus laparoscopic sacrocolpopexy (LSC) for the surgical management of apical or multicompartment pelvic organ prolapse (POP). Design: Systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies (PROSPERO CRD42025111099), conducted according to PRISMA guidelines. Setting: Secondary and tertiary care centres. Population: Women undergoing sacrocolpopexy for POP. Methods: Medical databases (PubMed, Scopus, ISI Web of Science, Embase, Cochrane) were searched from inception to April 2025 for studies comparing RASC versus LSC. Risk-of-bias was assessed using the Cochrane tool for RCTs and Joanna Briggs Institute checklists for observational studies. Data were meta-analysed separately by study design using odds ratios (ORs) and standardised mean differences with 95% confidence intervals (CIs), applying fixed- or random-effects models according to heterogeneity. Main Outcome Measures: Operative time, anatomical outcomes, complications, conversion to laparotomy, recurrence and patient-reported outcomes. Results: Five RCTs and twenty-four observational studies were included. In RCTs, no significant differences between RASC and LSC in operative time, anatomical outcomes or patient-reported outcomes were found, with similar intraoperative and post-operative complication rates. In observational studies, perioperative outcomes, complications, mesh exposure, readmissions and recurrence were comparable, but RASC ensured lower conversion to laparotomy (OR 0.2, 95% CI 0.1–0.3). Conclusions: RASC and LSC provide equivalent anatomical and clinical outcomes with similar morbidity. RASC may be particularly useful in complex or technically demanding cases.