Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study

Zanten, Femke van; Schans, Emma M. van der; Consten, Esther C. J.; Verheijen, Paul M.; Lenters, Egbert; Broeders, I. A. M. J.; Koops, Steven E. Schraffordt

doi:10.1097/dcr.0000000000001696

Cited by 10 publications

(9 citation statements)

References 29 publications

(43 reference statements)

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“…Patients treated for multicompartment prolapse with robot-assisted laparoscopic sacrocolpo-rectopexy (RSCR; with or without subtotal hysterectomy) were only considered for analysis of intraoperative safety of the rectopexy part, considering the substantial extra OT and burdening imposed by the additional sacrocolpopexy and subtotal hysterectomy. The rectopexy part of this procedure is identical to RVMR and has been described previously [13,14].…”

Section: Patient and Case Selectionmentioning

confidence: 99%

Evaluation of the learning curve of robot-assisted laparoscopic ventral mesh rectopexy

et al. 2021

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Background The current standard treatment for external rectal prolapse and symptomatic high-grade internal rectal prolapse is surgical correction with minimally invasive ventral mesh rectopexy using either laparoscopy or robotic assistance. This study examines the number of procedures needed to complete the learning curve for robot-assisted ventral mesh rectopexy (RVMR) and reach adequate performance. Methods A retrospective analysis of all primary RVMR from 2011 to 2019 performed in a tertiary pelvic floor clinic by two colorectal surgeons (A and B) was performed. Both surgeons had previous experience with laparoscopic rectopexy, but no robotic experience. Skin-to-skin operating times (OT) were assessed using LC-CUSUM analyses. Intraoperative and postoperative complications were analyzed using CUSUM analyses. Results A total of 182 (surgeon A) and 91 (surgeon B) RVMRs were performed in total. There were no relevant differences in patient characteristics between the two surgeons. Median OT was 75 min (range 46-155; surgeon A) and 90 min (range 63-139; surgeon B). The learning curve regarding OT was completed after 36 procedures for surgeon A and 55 procedures for surgeon B. Both before and after completion of the learning curve, intraoperative and postoperative complication rates remained below a predefined acceptable level of performance. Conclusions 36 to 55 procedures are required to complete the learning curve for RVMR. The implementation of robotic surgery does not inflict any additional risks on patients at the beginning of a surgeon's learning curve.

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Section: Patient and Case Selectionmentioning

confidence: 99%

Evaluation of the learning curve of robot-assisted laparoscopic ventral mesh rectopexy

et al. 2021

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“…Most recently, van Zanten et al have published long-term outcomes of their prospective cohort of 53 patients who underwent robot-assisted sacrocolporectopexy. 5 In this cohort, the median follow-up time was 48.2 months and 10 patients had prolapse recurrence: 2 (3.8%) had vaginal apical prolapse and 8 (15.1%) had internal rectal prolapse. Two (3.8%) patients underwent rectal prolapse reoperation and one (2.0%) patient had a vaginal mesh erosion which was managed conservatively.…”

Section: Outcomes Of Combined Repairsmentioning

confidence: 82%

“…2 For women with both rectal and pelvic organ prolapse, multidisciplinary evaluation and treatment 3 with combined rectal prolapse and pelvic organ prolapse surgery provide significant quality-of-life benefits by improving feelings of prolapse, pain, bladder, and bowel symptoms. 4,5 The advantages of one operation include a reduced risk of anesthesia, a single hospital stay and recovery period, decreased pain medications, and less time off work for the patient.…”

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confidence: 99%

Approaching Combined Rectal and Vaginal Prolapse

Wallace

Gurland

2021

Clin Colon Rectal Surg

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Combined rectal prolapse and pelvic organ prolapse surgery provides significant quality-of-life benefits with improvements in bothersome symptoms of pain, bulge, constipation, urinary retention, as well as bowel and bladder incontinence. Robotic surgery is the ideal tool for a combined surgical repair. It allows enhanced suturing in the deep pelvis, three-dimensional (3D) visualization of the presacral space and easy mobilization of the rectum and dissection of the vagina. Combined procedures can be offered to patients with the advantages of a single operation and concurrent recovery period without increasing complications. In this article, we highlight our approach to combined prolapse repair.

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“…Patients were counselled for redo RVMR or robot‐assisted resection rectopexy (RRR). An additional sacrocolpopexy was considered in cases of symptomatic multicompartment pelvic organ prolapse [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Patients with mesh erosion usually have symptoms of pain, dyspareunia, purulent or serosanguinous discharge and/or functional complaints [ 10 , 14 , 15 ]. Asymptomatic cases have also been described [ 15 , 16 ]. In severe cases, mesh erosion can lead to a rectovaginal fistula or spondylodiscitis.…”

Section: Introductionmentioning

confidence: 99%

Ninety‐day morbidity of robot‐assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years’ experience in a tertiary referral centre

et al. 2021

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Long-term Anatomical and Functional Results of Robot-Assisted Pelvic Floor Surgery for the Management of Multicompartment Prolapse: A Prospective Study

Cited by 10 publications

References 29 publications

Evaluation of the learning curve of robot-assisted laparoscopic ventral mesh rectopexy

Evaluation of the learning curve of robot-assisted laparoscopic ventral mesh rectopexy

Approaching Combined Rectal and Vaginal Prolapse

Ninety‐day morbidity of robot‐assisted redo surgery for recurrent rectal prolapse, mesh erosion and pelvic pain: lessons learned from 9 years’ experience in a tertiary referral centre

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