Long-term Outcomes of Robot-assisted Laparoscopic Rectopexy for Rectal Prolapse

Perrenot, C.; Germain, A; Scherrer, M; Ayav, Ahmet; Brunaud, Laurent; Bresler, L.

doi:10.1097/dcr.0b013e318289366e

Cited by 39 publications

(29 citation statements)

References 16 publications

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“…Laparoscopic ventral mesh rectopexy (LVMR) is emerging as the treatment of choice for rectal prolapse in Europe [3]. More recently, ventral mesh rectopexy has been performed using a robotic approach with evidence supporting feasibility, safety and good functional outcomes [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. A robotic approach is a particularly useful technique in the restricted space of the pelvis due to enhanced visibility from greater field magnification and three-dimensional imaging, as well as improved dexterity from the use of multiarticulated instruments, elimination of physiologic tremor and an improved eye-hand-target axis [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, there is evidence to suggest that compared to laparoscopic surgery, robotic surgery may provide ergonomic benefits for the surgeon [19,20]. Most reports of robotic ventral mesh rectopexy (RVMR) come from singleinstitution reviews in Europe and typically include a combined analysis of RVMR along with other types of laparoscopic and/or robotic surgery for rectal prolapse [4][5][6][7][8][9][10][11][12][13][14]. To our knowledge, this report is the first to focus on outcomes of RVMR for rectal prolapse in the USA.…”

Section: Introductionmentioning

confidence: 99%

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Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience

et al. 2017

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“…Robotic dissections for benign rectal disease, rectal prolapse and inflammatory bowel disease, however, are not as well described [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience

2014

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Background Data is limited about the robotic platform in rectal dissections, and its use may be perceived as prohibitively expensive or difficult to learn. We report our experience with the initial robotic-assisted rectal dissections performed by a single surgeon, assessing learning curve and cost. Methods Following IRB approval, a retrospective chart review was conducted of the first 85 robotic-assisted rectal dissections performed by a single surgeon between 9/1/2010–12/31/2012. Patient demographic, clinicopathologic, procedure, and outcome data were gathered. Cost data was obtained from the University HealthSystem Consortium (UHC) database. The first 43 cases (Time 1) were compared to the next 42 cases (Time 2) using multivariate linear and logistic regression models. Results Indications for surgery were cancer for 51 patients (60%), inflammatory bowel disease for 18 (21%), and rectal prolapse for 16 (19%). The most common procedures were low anterior resection (n=25, 29%) and abdominoperineal resection (n=21, 25%). The patient body mass index (BMI) was statistically different between the two patient groups (Time 1, 26.1 kg/m2 vs. Time 2, 29.4 kg/m2, p=0.02). Complication and conversion rates did not differ between the groups. Mean operating time was significantly shorter for Time 2 (267 minutes vs. 224 minutes, p=0.049) and remained significant in multivariate analysis. Though not reaching statistical significance, the mean observed direct hospital cost decreased ($17,349 for Time 1 vs. $13,680 for Time 2, p=0.2). The observed/expected cost ratio significantly decreased (1.47 for Time 1 vs. 1.05 for Time 2, p=0.007) but did not remain statistically significant in multivariate analyses. Conclusions Over the series, we demonstrated a significant improvement in operating times. Though not statistically significant, direct hospital costs trended down over time. Studies of larger patient groups are needed to confirm these findings, and to correlate them with procedure volume to better define the learning curve process.

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“…Since then several other case series using a variety of techniques have been described. [50][51][52] Outcomes in these studies showed low recurrence rates and good functional outcomes. A recent meta-analysis comparing laparoscopic to robotic ventral mesh rectopexy found that robotic rectopexy had similar functional outcomes and conversion rates compared with laparoscopy but longer operative times with increased costs.…”

Section: Robotic Rectopexymentioning

confidence: 99%

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

Andolfi

Umanskiy

2019

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Background: Robotic technology aims to obviate some of the limitations of conventional laparoscopic surgery, yet the role of robotics in colorectal surgery is still largely undefined and varies with respect to its application in abdominal versus pelvic surgery. Methods: With this review, we aimed to highlight current developments in colorectal robotic surgery. We systematically searched the following databases: PubMed, EMBASE, and Cochrane Library. We critically reviewed the available literature on the use of robotic technology in colon and rectal surgery. Results: Robotic colorectal surgery is oncologically safe and has short-term outcomes comparable to conventional laparoscopy, with potential benefits in rectal surgery. It has a shorter learning curve but increased operative times and costs. It offers potential advantages in the resection of rectal cancer, due to lower conversion rates. There is also a trend toward better outcomes in anastomotic leak rates, circumferential margin positivity, and perseveration of autonomic function. Conclusion: Laparoscopy remains technically challenging and conversion rates are still high. Therefore, most cases of colorectal surgery are still performed open. Robotic surgery aims to overcome the limits of the laparoscopic technique. This new technology has many advantages in terms of articulating instruments, advanced three-dimensional optics, surgeon ergonomics, and improved accessibility to narrow spaces, such as the pelvis. However, further studies are needed to assess long-term results and benefits.The first report on laparoscopic right colectomy was published by Jacobs et al. 1 ; shortly following that Fowler performed the first laparoscopic left colectomy. Since these initial reports, several large studies found that the oncologic outcomes of laparoscopic colectomy were equivalent to open surgery. Despite the growing evidence supporting the use of laparoscopic colectomy for colon cancer, the adoption of this technique was relatively slow due to some limitations: loss of stereoscopic vision and depth perception, paradoxical motion of the instruments, amplified movements, parallel instrumentation, and suboptimal ergonomics. To overcome these shortfalls, the use of hand-assisted laparoscopy was introduced as a bridge between open and laparoscopic surgery. 2,3 Robotic colectomy was first reported in 2002 and since that time adoption of robotic surgery has steadily increased, as evidenced by the number of publications in both medical and lay press. The da Vinci robotic system, the only currently available robotic system in the market approved by the FDA for colorectal surgery, provides several advantages over traditional laparoscopic surgery including a stable camera platform, threedimensional (3D) imaging, improved ergonomics, tremor elimination, ambidextrous capability, motion scaling, and

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Long-term Outcomes of Robot-assisted Laparoscopic Rectopexy for Rectal Prolapse

Abstract: Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.

Cited by 39 publications

References 16 publications

Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience

Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience

An initial experience with 85 consecutive robotic-assisted rectal dissections: improved operating times and lower costs with experience

Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery

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