Background: Laparoscopic ventral mesh rectopexy (LVR) is a treatment with promising results in external rectal prolapse, rectal intussusception, and rectocele. Because of the emergence of robotic-assisted surgery and the technical advantage it provides, we examined the potential role and place of robotic surgery in ventral rectopexy.
Methods: MEDLINE, PubMed, and other databases were searched, by two independent reviewers, to identify studies comparing robotic to laparoscopic ventral mesh rectopexy. The primary outcome was the rate of unplanned conversion to open. The secondary outcomes were morbidity, length of hospital stay and recurrence rate.
Results: Five studies (4% male, n = 259) met the inclusion criteria. All 5 studies reported on conversion rate and showed no significant difference between the conversion rate of robotic and laparoscopic groups [OR 0.58 (95% CI 0.09-3.77)]. Robotic surgery was also similar to laparoscopic surgery for both morbidity [OR 0.71 (95% CI 0.34-1.48)] and recurrence rate [OR 0.56 (95% CI 0.18-1.75)]. Operative time was longer in the robotic group with a MWD of 22.88 minutes (CI 5.73-40.04, p < 0.0007). There was a statistically significant reduction in length of stay with robotic surgery [mean difference - 0.36 days (95% CI - 0.66 to - 0.07)].
Conclusions: This systematic review shows that robotic-assisted ventral rectopexy requires longer operative time with no significant added benefit over laparoscopic ventral rectopexy. The conversion rate was low in both groups and the trends to benefit did not reach statistical significance. More studies are required to clarify whether the potential technical advantage of robotic surgery in ventral rectopexy translates to an improvement in clinical outcome.
Keywords: Laparoscopic surgery; Rectal prolapse; Robotic surgery; Ventral mesh rectopexy.
Robot-assisted vs Laparoscopic Ventral Rectopexy for External or Internal Rectal Prolapse and Enterocele: A Randomized Controlled TrialJ Mäkelä-Kaikkonen et al. Colorectal Dis 18 (10), 1010-1015. PMID 26919191. - Randomized Controlled TrialRobot-assisted laparoscopic ventral rectopexy can be performed safely and within the same operative time as conventional laparoscopy. Minimally invasive ventral rectopexy …
Is Robotic Ventral Mesh Rectopexy Better Than Laparoscopy in the Treatment of Rectal Prolapse and Obstructed Defecation? A Meta-AnalysisL Ramage et al. Tech Coloproctol 19 (7), 381-9. PMID 26041559. - ReviewVentral mesh rectopexy is an approach in the treatment of internal and external rectal prolapse and rectocele. Our aim was to assess whether robotic surgery confers any s …
Laparoscopic Ventral Rectopexy Versus Laparoscopic Wells Rectopexy for Complete Rectal Prolapse: Long-Term ResultsKM Madbouly et al. J Laparoendosc Adv Surg Tech A 28 (1), 1-6. PMID 28586260.In this study, both LVR and LWR successfully and safely corrected the prolapse and prevented recurrence in patients after long-term follow-up. Operative time and hospital …
Robotic-assisted and Laparoscopic Ventral Rectopexy in the Treatment of Rectal Prolapse: A Matched-Pairs Study of Operative Details and ComplicationsJ Mäkelä-Kaikkonen et al. Tech Coloproctol 18 (2), 151-5. PMID 23839795.Robotic-assisted laparoscopic ventral rectopexy is safe, feasible and not more time consuming than the laparoscopic technique even at the beginning of the learning curve. …
Current Status of Laparoscopic and Robotic Ventral Mesh Rectopexy for External and Internal Rectal ProlapseJJ van Iersel et al. World J Gastroenterol 22 (21), 4977-87. PMID 27275090. - ReviewExternal and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain …