Sacrocolpopexy is considered the gold standard surgical treatment for apical pelvic organ prolapse (POP). Minimally invasive approaches, including laparoscopic sacrocolpopexy (LASC) and robotic-assisted sacrocolpopexy (RASC), have been increasingly adopted due to reduced morbidity and faster recovery compared with open surgery. While robotic technology may offer technical advantages such as improved visualization and instrument dexterity, evidence demonstrating clear clinical benefits over conventional laparoscopy remains limited. Moreover, most available studies report short- to mid-term outcomes, and randomized data with long-term follow-up are scarce. Therefore, long-term comparative evidence is needed to better understand the durability and outcomes of these two minimally invasive approaches.

This report provides the long-term update of our original randomized trial comparing RASC and LASC. The initial cohort of 100women was prospectively followed with standardized visits at 1, 3, 6, and 12 months and annually thereafter through January 2025to assess anatomical outcomes, urinary and sexual function, and late complications.The trial was approved by local ethicscommittee.All calculations were performed with IBM® SPSS®, version 22.0

Ninety-six patients were available for final analysis (Fig.1).Mean follow-up was 106±3.4 months.Apical success was 95.8% afterRASC vs 93.8% after LASC, with 2 apical recurrences in the RASC group and 3 in the LASC group. One recurrence in each grouprequired reoperation; others were stage II and asymptomatic. This difference was not statistically significant (p = 1.0).Two additionalanterior stage-II recurrences occurred only in the LASC group, both asymptomatic without voiding dysfunction.De-novo stressurinary incontinence occurred in 15 RASC (31.3%) vs 12 LASC (25.0%) (p = 0.65). De-novo urgency incontinence occurred in 10RASC (20.8%) vs 18 LASC (37.5%) (p = 0.12).Mesh exposure remained rare (2 RASC, 3 LASC) and was recorded exclusively inthe early postoperative period up to 2017. No additional mesh-related events or other major late complications occurred during long-term follow-up. Pelvic floor, urinary, sexual, and anorectal function improvements were sustained in both groups.

The similar long-term outcomes observed in both groups likely reflect that the key determinants of sacrocolpopexy success are the surgical principles of apical suspension and mesh fixation rather than the surgical platform used. Consequently, robotic and laparoscopic approaches appear to provide comparable durability and functional benefits over time.

This extended follow-up of our randomized trial demonstrates that robotic-assisted and laparoscopic sacrocolpopexy providesimilarly durable anatomical and functional outcomes for advanced pelvic organ prolapse. After nearly nine years, apical successrates remained high and statistically comparable between groups, with low recurrence and reoperation rates and no additional latemesh-related complications beyond those identified in the early postoperative period. Both approaches preserved long-term pelvicfloor, urinary, sexual, and anorectal function. These findings confirm that, in experienced hands, robotic and laparoscopicsacrocolpopexy are equally effective and safe long-term surgical options for the management of high-stage prolapse