Anatomical and functional outcomes of combined ventral rectopexy and sacrocolpo/hysteropexy for multicompartment pelvic organ prolapse: a systematic review and meta-analysis Alessandro Ferdinando Ruffolo, Tomaso Melocchi, Chrystèle Rubod, Yohan Kerbage, Giuseppe Campagna, Sara Mastrovito, Alfredo Ercoli, Giovanni Panico, Michel Cosson, Marine Lallemant Techniques in Coloproctology, 2026 Introduction Limited data exists in literature regarding concomitant ventral rectopexy (VRP) and sacrocolpo/hysteropexy (SCP/SHP), with existing studies being predominantly retrospective. The aim of this meta-analysis is to assess the anatomical and functional outcomes of combined VRP and SCP/SHP for the treatment of multicompartmental pelvic organ prolapse (POP). Methods We performed systematic research and meta-analysis from PubMed/MEDLINE and EMBASE, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, until 15 January 2025. Women submitted to VRP with SCP/SHP were included. Improvement of anorectal symptoms were evaluated. Postoperative anatomical relapse was reported. Re-operation rates were evaluated. Results Six articles were included. Constipation/obstructed defecation syndrome (ODS) [odds ratio (OR) 0.26, 95% CI 0.10–0.68; p = 0.006 ( I 2 test 81%, p = 0.56)] and of anal/fecal incontinence (AI/FI) rates [OR 0.09, 95% CI 0.03–0.30; p < 0.0001 ( I 2 test 70%, p = 0.04)] significantly improved after combined VRP and SCP/SHP. The proportion metanalysis of four included studies reported a subjective POP recurrence rate of 7% (95% CI 1–13%; I 2 test 82.9%, p < 0.001). The proportion metanalysis of five included studies for objective POP recurrence was 5% (95% CI 1–9%; I 2 test 56.9%, p = 0.041). No serious adverse events were reported. Conclusions VRP combined with SCP/SHP has been shown to be safe and effective for women with multicompartment POP, providing optimal anatomical and functional outcomes. Larger, long-term, prospective-controlled studies are needed to confirm these results.
Step-by-step combined surgical approach to successfully repair complex and challenging vesico-vaginal fistulas: Insights from a case series Martina Arcieri, Stefano Restaino, Veronica Tius, Andrea Lombisani, Davide Arrigo, Lavinia Porto, Giovanni Panico, Daniela Caramazza, Lorenzo Vacca, Giuseppe Campagna, Canio Martinelli, Giuseppe Vizzielli, Alfredo Ercoli Acta Obstetricia Et Gynecologica Scandinavica, 2026 Introduction Several surgical approaches are available for the repair of complex vesico‐vaginal fistulas; however, robust clinical evidence and standardization of techniques are lacking. Complex vesico‐vaginal fistula is defined as either a recurrent fistula following primary surgical repair or a fistula related to prior pelvic surgery and/or radiotherapy. The aim of this study was to describe a step‐by‐step combined vaginal and laparoscopic technique and to assess its feasibility, safety, and efficacy. Material and Methods A retrospective study was performed between 2016 and 2023, involving patients diagnosed with complex vesico‐vaginal fistulas. Clinical, perioperative, and postoperative data were collected. The surgical technique was standardized, described, and executed by an experienced surgeon in each case. Postoperative urogynecological follow‐up was scheduled at one month, 3 months, 6 months, and one year. Results A total of 20 patients were included in the study. Fifteen patients developed vesico‐vaginal fistulas after total hysterectomy, four after radical hysterectomy combined with radiotherapy, and one following a cesarean section. Four patients had a prior diagnosis of gynecological cancer, four had received pelvic radiotherapy, and two had undergone previous chemotherapy. Twenty‐five percent of the patients exhibited VVF in the trigone area. The median operative time was 317 min (ranging from 250 to 508 min). One minor postoperative complication occurred, and there was no conversion to laparotomy. All repairs were watertight. The median length of hospital stay was 4 days (ranging from 2 to 6 days). No recurrences were observed during the follow‐up period, lasting 42 months on average. Conclusions This study demonstrated the feasibility and safety of a new surgical approach for repairing complex urogenital fistulas.
Port placement and patient-specific docking strategies for robotic hysterectomy with the Hugo™ RAS system: an international Delphi consensus Diego Raimondo, Enrico Pazzaglia, Helder Ferreira, Meera Ragavan, Anne Katrine Friberg, Mads Nielsen-Breining, Giorgia Monterossi, Giovanni Panico, Andrea Rosati, Sara Mastrovito, Kristine Juul Hare, Danny Chou, Eric Francescangeli, Jordi Cassadò Garriga, Stefano Palmieri, Harald Krentel, Laurent de Landsheere, Dimitrios Balafoutas, Mohamed Mabrouk, Renato Seracchioli, Francesco Fanfani Facts Views and Vision in Obgyn, 2026 Background: Robotic-assisted hysterectomy is increasingly performed using modular platforms such as the Hugo™ roboticassisted surgery (RAS) system, but optimal or personalised docking strategies remain undefined. Objectives: To establish expert consensus on port placement and docking configurations for hysterectomy with the Hugo™ RAS system and to identify patient anthropometric factors requiring modification of standard setups. Methods: A modified Delphi consensus was conducted involving two iterative rounds of anonymous, structured questionnaires distributed to an international panel of gynaecological robotic surgeons experienced with the Hugo™ RAS system. Survey items addressed preferred docking configurations, the influence of patient anthropometry on docking strategy, and specific technical adjustments in non-standard scenarios. Consensus was predefined as ≥66.7% agreement. Main Outcome Measures: Expert agreement on docking setups, port placement modifications, and anthropometric variables influencing technical adjustments. Results: Seventeen experts completed round one and 16 completed round two. No single docking configuration reached consensus as universally optimal for standard hysterectomy. Ranking exercises identified the "standard" hysterectomy setup as the most preferred configuration, followed by the "alternate" and the "three-arm" setups. All experts agreed that patient anthropometry requires modification of port placement. Elevated body mass index (BMI), large uterine size and small pelvis were identified as key variables: increasing inter-port distance was recommended for BMI >30, cranial port displacement for large uteri, while no consensus emerged for patients with a small pelvis. A modified bridge configuration was proposed, and achieved strong expert agreement. Conclusions: No single docking configuration is deemed to be universally optimal for Hugo™ RAS hysterectomy. Expert practice combines a limited number of preferred setups with patient-tailored adjustments. What is New?: This study provides the first Delphi-based expert consensus on Hugo™ RAS docking strategies, emphasizing patient-specific adjustments and flexible preoperative planning.
Comparative outcomes of Hugo™ robotic and laparoscopic sacrocolpopexy in a high-volume tertiary center: a propensity-matched study S. Mastrovito, Davide Arrigo, C. Riccetti, G. Campagna, F. Natale, A. Ercoli, A. Fagotti, F. Fanfani, G. Panico Journal of Robotic Surgery, 2025 Objective Minimally invasive sacrocolpopexy (SCP) is regarded as the gold standard procedure for treating Pelvic Organ Prolapse (POP). Robotic-assisted surgery has emerged as a solid alternative to laparoscopy. Recently, novel platforms have been introduced, including the Hugo RAS (MEDTRONIC Inc, USA), a modular system featuring independent bedside units and an open-designed console. Although solid evidence has shown comparable outcomes between RAS and laparoscopy, there is still limited evidence on the safety and feasibility of novel multi-arm robotic platforms. Design We conducted a retrospective study analyzing data from 450 patients undergoing minimally invasive SCP (May 2022-December 2023), using propensity score matching to correct for treatment selection bias. The primary aim was to assess differences in 30-day Clavien-Dindo grade ≥ II complications, Secondary outcomes included intraoperative complications, estimated blood loss, operative time, length of hospital stay, and functional outcomes, to assess overall safety, feasibility, and outcomes of laparoscopic versus robotic-assisted SCP performed with the Hugo RAS system. Setting All patients underwent minimally invasive SCP at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Participants After excluding patients with missing data or incomplete follow-up and PSM, 284 patients were compared, 142 who underwent laparoscopic SCP and 142 who underwent robotic SCP with the Hugo™ RAS system. Intervention The study aims to compare laparoscopic and robotic SCP performed with the Hugo™ RAS platform. Results Short- to mid-term outcomes were compared. RAS did not significantly differ from laparoscopy in terms of intra- or post-operative complications and length of hospitalization. The robotic group showed a slightly longer operative time and slightly lower intraoperative blood loss. The mean follow-up was 18 months (range 12–36) and a statistically significant improvement of objective and subjective outcomes was reported in both populations, with high satisfaction rate. Conclusions The Hugo™ RAS system resulted safe and effective to perform SCP for symptomatic POP, representing a feasible alternative to laparoscopy. These findings support its use as an alternative for the treatment of symptomatic POP and contribute to expanding the evidence for newer robotic platforms in urogynecologic and reconstructive pelvic surgery.
Using cumulative summation analysis for the learning curve of robotic docking time in radical prostatectomy with the HUGO RAS System Pierluigi RUSSO, Mariachiara SIGHINOLFI, Sara MASTROVITO, Antonio CRETÌ, Giovanni PANICO, Filippo MARINO, Simona PRESUTTI, Eros SCARCIGLIA, Francesco P. BIZZARRI, Domenico NIGRO, Carlo GANDI, Mauro RAGONESE, Filippo GAVI, Savio D. PANDOLFO, Angelo TOTARO, Emilio SACCO, Nazario FOSCHI, Bernardo ROCCO Minerva Urology and Nephrology, 2025 Minimally invasive surgery like robotic surgery is known to yield better outcomes in terms of blood loss, blood transfusion, and length of stay, and robot-assisted radical prostatectomy provides a clear example compared to open surgery. It is still constrained by issues related to platform availability and cost-effectiveness. Introducing new robotic platforms, such as the HUGO™ Robot-Assisted Surgery (RAS) System, could lead to longer operating times caused by the surgeon’s learning curve, system configuration, adjustment of robotic devices, and robotic docking. Several studies have assessed the influence of resident physicians on outcomes in urological surgeries. Our main objective was to evaluate the learning curve of the docking time for 195 radical prostatectomies performed in our hospital. The results of our research indicate that the setup and docking process with the HUGO RAS system can be accomplished with ease, and the learning curve for robotic docking is consistent with the available data for other robotic platforms. Our training facilitated a rapid docking process and seamless completion of the surgery.
Laparoscopic management of presacral retroperitoneal haematoma after sacrocolpopexy Giovanni Panico, Sara Mastrovito, Davide Arrigo, Camilla Riccetti, Giuseppe Campagna, Giovanni Scambia, Alfredo Ercoli Facts Views and Vision in Obgyn, 2025 Background: Minimally invasive sacrocolpopexy (SCP) has emerged as the gold standard procedure for pelvic organ prolapse. However, it entails a deep surgical dissection, essential for proper mesh positioning, and is not devoid of intraoperative and postoperative complications, including sporadic cases of potentially life-threatening intraoperative bleeding or postoperative haematomashaematomas. The appropriate management of bleeding complications in this area varies depending on the individual case and presence of hemodynamic instability, from emergency open surgery to a conservative wait-and-see approach. Objectives: To illustrate an effective method for the management of bleeding complications of SCP and raise awareness about this unusual complication. Participant: A 69-year-old woman underwent laparoscopic revision surgery due to evidence of a voluminous presacral haematoma on the second postoperative day after SCP. Intervention: The effectiveness of minimally invasive revision surgery for the management of voluminous presacral haematoma following laparoscopic SCP was assessed. Laparoscopic revision surgery allowed for the complete drainage of the haematoma without complications, resulting in discharge on postoperativeday seven. Conclusions: The video reviews the steps of the laparoscopic approach for performing a successful and safe revision surgery to manage presacral haematomas after SCP, and illustrates the procedure's adaptability, also providing specific tips and tricks to successfully perform this procedure without the need for mesh removal, thereby preserving the best outcome for the patient. What is New?: This is the first description of the surgical management of a retroperitoneal hematoma following colposacropexy. The study's conclusions provide a valuable resource for gynecologists facing patients presenting with a retroperitoneal presacral hematoma after prosthetic surgery for prolapse.
Myoma expulsion after minimally invasive therapeutic strategies: a systematic review Gianluca Raffaello Damiani, Maria Bardi, Amerigo Vitagliano, Anna Myriam Perrone, Giovanni Panico, Antonella Vimercati, Vera Loizzi, Daniele Di Gennaro, Edoardo Di Naro, Ettore Cicinelli, Antonio Malvasi, Andrea Tinelli, Giorgio Maria Baldini, Antonio Maurizio Pellegri European Journal of Obstetrics and Gynecology and Reproductive Biology, 2025
Titanized polypropylene mesh in laparoscopic sacral colpopexy Giuseppe Campagna, Luigi Pedone Anchora, Giovanni Panico, Daniela Caramazza, Martina Arcieri, Mauro Cervigni, Giovanni Scambia, Alfredo Ercoli International Urogynecology Journal, 2020
Rectal mesh erosion after posterior vaginal kit repair Giuseppe Campagna, Giovanni Panico, Daniela Caramazza, Monia Marturano, Alfredo Ercoli, Giovanni Scambia, Mauro Cervigni International Urogynecology Journal, 2019
The evolution of materials in the use of sub-urethral sling Tension Free (TOT) in the surgical treatment of female SUI Urogynaecologia International Journal, 2008
