Robotic sacrocolpopexy (RSC) is increasingly adopted for the treatment of apical pelvic organ prolapse (POP), offering improved ergonomics, three-dimensional visualization, and enhanced dexterity compared with conventional laparoscopy. However, the number of procedures required to achieve surgical proficiency remains unclear. This study aimed to evaluate the learning curve of robotic sacrocolpopexy by analyzing operative performance and perioperative outcomes in a single-center experience.

A retrospective analysis was conducted on 52 consecutive patients who underwent robotic sacrocolpopexy for symptomatic apical POP between 2024 and 2026 at a tertiary referral center. All procedures were performed by a surgeon experienced in pelvic reconstructive surgery but at the beginning of robotic practice. Patients were divided into two groups according to surgical sequence (cases 1–26 vs 27–52). Operative time, estimated blood loss, intraoperative complications, and postoperative outcomes were assessed. The learning curve was evaluated by analyzing trends in operative time across consecutive cases.Statistical analysis was performed using standard comparative methods. Continuous variables were expressed as median values and compared between the two groups using the Mann–Whitney U test. Categorical variables were presented as frequencies and percentages and compared using the chi-square test or Fisher’s exact test when appropriate. A p-value < 0.05 was considered statistically significant. Trends in operative time across consecutive cases were analyzed to evaluate the learning curve

A total of 52 patients underwent robotic sacrocolpopexy during the study period. Patients were divided according to surgical chronology into an early phase (cases 1–26) and a late phase (cases 27–52) to evaluate the learning curve.
A significant reduction in operative time was observed between the two phases. The median operative time decreased from 198 minutes in the early phase to 142 minutes in the late phase, corresponding to an absolute reduction of 56 minutes and a 28% decrease in operative duration (p < 0.01).Estimated blood loss also decreased during the learning curve, from 110 ml in the early phase to 70 ml in the late phase, representing a reduction of 50 ml (41%).
Intraoperative complications were rare. One complication occurred in the early phase (1/26, 3.8%) compared with none in the late phase (0/26, 0%). No conversions to open surgery were required.Postoperative outcomes remained stable throughout the series. The median length of hospital stay was 2 days in both groups, with no significant differences between phases.At short-term follow-up, anatomical success was achieved in 49 out of 52 patients (94%). No early mesh exposure, mesh infection, or reoperation for complications were observed.Overall, these results demonstrate a clear improvement in surgical efficiency during the learning curve, with a marked reduction in operative time while maintaining stable perioperative outcomes and a high success rate.A plateau in operative time appeared to be reached after approximately 25–30 procedures, suggesting that surgical proficiency in robotic sacrocolpopexy may be achieved within the first half of the series for surgeons experienced in pelvic reconstructive surgery.

The progressive reduction in operative time likely reflects the surgeon’s increasing familiarity with robotic instrumentation, improved efficiency in key procedural steps such as dissection, mesh fixation, and peritoneal closure, and optimization of operating room workflow. Importantly, this improvement in surgical efficiency did not occur at the expense of safety, as complication rates and postoperative outcomes remained stable. These findings suggest that prior experience in pelvic reconstructive surgery may significantly shorten the learning curve of robotic sacrocolpopexy.

Robotic sacrocolpopexy shows a relatively short learning curve for surgeons experienced in pelvic reconstructive surgery. In this series, surgical proficiency was achieved after approximately 25–30 procedures, with significant improvements in operative time while maintaining excellent perioperative outcomes. These findings support the safe implementation of robotic sacrocolpopexy in specialized pelvic floor centers