Abstract
BackgroundThe aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome.MethodsA prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February–May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up.ResultsThere were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were ‘much better’ (RVMR) and ‘slightly better’ (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83).ConclusionsAlthough more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques.
Highlights
External rectal prolapse (ERP) and internal rectal prolapse (IRP) with symptoms of obstructed defecation and/or fecal incontinence are debilitating conditions resulting in impairment of the patients’ quality of life [1]
The aim of this study was to evaluate the incremental cost-effectiveness in terms of cost per quality-adjusted life year (QALY) gained of robot-assisted ventral mesh rectopexy (RVMR) compared to laparoscopic ventral mesh rectopexy (LVMR) using hospital perspective and secondarily, to compare the effect of RVMR and LVMR for posterior compartment procidentia on pelvic floor anatomy and function in the long-term
An improvement was seen in pelvic floor distress inventory scores (PFDI) and in the colorectal-anal (CRADI) and pelvic organ prolapse (POPDI) subscales
Summary
External rectal prolapse (ERP) and internal rectal prolapse (IRP) with symptoms of obstructed defecation and/or fecal incontinence are debilitating conditions resulting in impairment of the patients’ quality of life [1]. The role of robot-assisted laparoscopy in treating posterior pelvic floor dysfunction is undetermined, based on current evidence of non-randomized relatively small comparative series of rectopexy operations [11,12,13]. It is not known, if robotic ventral mesh rectopexy (RVMR) offers improvements in medical care and operative outcomes in the form of better anatomical and functional results, improved health-related quality of life (HRQoL) and a reduced recurrence rate. The aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome. The effect on HRQoL is minor, with no differences between techniques
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