Trifecta Outcomes after Robotic Sacrocolpopexy with Dual Mesh in Single-center Cohort

Objectives: To evaluate anatomical, functional, and safety outcomes of robotic-assisted sacrocolpopexy (RASC) using a novel trifecta endpoint. Methods: Single-center study including 100 consecutive patients undergoing RASC between June 2017 and January 2024 at the University of Foggia. Exclusion criteria were follow-up <12 mo, lack of objective evaluation, and preoperative or occult stress urinary incontinence (SUI) on urodynamics. The trifecta outcome was defined as the simultaneous presence of: a) absence of significant pelvic organ prolapse (POP) recurrence, defined as halfway system (HWS) >1 or POP-Q stage >I at follow-up; b) absence of surgery-requiring de novo SUI; c) absence of postoperative major complications, defined as Clavien-Dindo grade ≥II. Outcomes were assessed at routine visits. Continuous variables are reported as median (IQR) and categorical variables as n (%). Results: Median age was 65 yr (IQR 59-70) and body mass index (BMI) 27 kg/m2 (25-28); 20% had previous POP surgery. Operative time was 115 min (IQR 91-130), hemoglobin drop 1.1 g/dl, hospital stay 3 d (IQR 2-3). Median follow-up was 18 mo (IQR 13-24). Significant POP recurrence (defined as HWS >1 or POP-Q stage >I) occurred in 4% of patients. Surgery-requiring de novo SUI occurred in 2%. Postoperative major complications (Clavien-Dindo ≥II) occurred in 4%. Overall, 90% of patients simultaneously met all three trifecta criteria. Conclusions: Robotic-assisted sacrocolpopexy with dual meshes provided stable anatomic outcomes with low rates of surgery-requiring de novo SUI and Clavien-Dindo ≥ II complications. The 90% trifecta supports its safety and effectiveness and suggests its utility as a benchmark in prolapse surgery.