Robotic-assisted Rectopexy Research Articles

Increased cost burden associated with robot-assisted rectopexy: do patient outcomes justify increased expenditure?

Robot-assisted surgical techniques have flourished over the years, with refinement in instrumentation and optics allowing for adaptation and increasing utilization across surgical fields. Transabdominal rectopexy with mesh for rectal prolapse may stand to benefit significantly from the use of a robotic platform. However, increased operative times and immediate associated costs of robotic surgery may provide a counterargument to widespread adoption. To determine which approach to the treatment of rectal prolapse, laparoscopic or robotic, is more cost effective and provides better outcomes with fewer complications, a retrospective review was performed at a single tertiary care academic institution from May 2013 to December 2020. Twenty-two patients underwent transabdominal mesh rectopexy through a robot-assisted DaVinci platform (Intuitive Sunnyvale, CA), and thirty through a laparoscopic platform. Main outcome measures included operative, hospital, and total cost as defined by total charges billed. Secondary outcomes included rate of recurrence, intra-operative complications, median operative time, post-operative complications, average hospital length of stay, inpatient pain medication usage, and post-operative functional outcomes. Cost analysis for robot-assisted versus laparoscopic rectopexy demonstrated operating room costs of $46,118 ± $9329 for the robotic group, versus $33,090 ± $15,395 (p = 0.002) for the laparoscopic group. Inpatient hospital costs were $60,723 ± $20,170 vs. $40,798 ± $14,325 (p = 0.001), and total costs were $106,841 ± $25,513 vs. $73,888 ± $28,129 (p ≤ 0.001). When secondary outcomes were compared for the robotic versus laparoscopic groups, there were no differences in any of the aforementioned outcome variables except for operative time, which was 79min longer in the robotic group (p ≤ 0.001). Robot-assisted mesh rectopexy demonstrated no clinical benefit over traditional laparoscopic mesh rectopexy, with significantly higher operative and hospital costs. A reduction in the acquisition and maintenance costs for robotic surgery is needed before large-scale adoption and implementation of the robotic platform for this procedure.

Robot-assisted or conventional laparoscoic rectopexy for rectal prolapse? Systematic review and meta-analysis

Aim: The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated. Methods: A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR). Results: Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete. Conclusion: The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.

Robot-assisted rectopexy and colpopexy for rectal prolapse

This video demonstrates a technique for robot-assisted combined rectopexy with colpopexy, but without the use of mesh for rectal prolapse. This case features a 61-year-old woman who presents with complaints of tissue protruding through her rectum and fecal incontinence. On examination, she was found to have circumferential, full-thickness rectal prolapse and perineal descent. We present a technique that combines rectopexy with colpopexy without the use of mesh for repair of rectal prolapse. Postoperative examination revealed resolution of rectal prolapse and good perineal support. This video illustrates a technique that may serve as a useful adjunct to have in one's surgical armamentarium in circumstances when mesh should not or cannot be used, such as in cases that require resection of the sigmoid colon or for patients who simply prefer to avoid the use of mesh. Given that rectal prolapse and posthysterecomy vaginal vault prolapse often occur together, our institution routinely performs colpopexy with rectopexy for rectal prolapse to provide additional support to the pelvic floor as demonstrated in this video.

Su1604 Outcomes for Robotic-Assisted Rectopexy With or Without Sigmoid Colon Resection for Rectal Prolapse

Purpose : Our experience in robotic-assisted rectopexy with sigmoid colon resection (RAR+SR) or without sigmoid colon resection (RAR) was reviewed to determine if there was a significant difference in intra-operative or postoperative outcomes. Methods : We retrospectively reviewed 26 patients that underwent robotic-assisted rectopexy for rectal prolapse from 2006 to 2012. Rectopexy is performed with primary suture pexy and without mesh. Continuous variables were analyzed by t-test, while Fisher's exact test was applied for categorical data. Results : Twenty-two patients underwent RAR and 4 patients underwent RAR+SR. The average age for study participants was 56 years (range 21-78 years) and consisted of 4 men and 22 women. Recurrent rectal prolapse occurred in 2 patients at 3 and 30 months after surgery in the RAR group and no recurrence occurred in the RAR+SR group (p=1.00). The duration of surgery for RAR was 211 minutes versus 309 minutes for RAR+SR (p,0.001, CI 60.8 135.4). Intra-operative blood loss for RAR was 97.8mL compared to 87.5mL for RAR+SR (p=0.924, CI -77.4 89.7). Conversion to open procedure occurred twice with RAR and once with RAR+SR (p=0.407). Length of hospitalization averaged 3 days for RAR and 4 days for RAR+SR (p=0.196, CI -0.2 2.2). The mean follow up was 127 days (range 1-72 months). Eight of 10 patients with preoperative constipation subjectively noted improvement with RAR versus 1 of 2 patients with RAR+SR (p=0.455). Six of 10 patients with preoperative fecal incontinence had subjectively improved symptoms with RAR versus 1 of 2 patients with RAR+SR (p=1.00). Six patients in the RAR group experienced a postoperative complication (over-sedation, corneal abrasion, atrial flutter, pulmonary edema, pelvic hematoma, ileus) versus 1 complication (urinary retention) after RAR+SR (p=0.924). There were no mortalities and no complications requiring operative intervention. Conclusions : The majority of patients underwent RAR and outcomes for RAR versus RAR+SR were not significantly different in this series with the exception of increased operative time for RAR+SR. The recurrence rate was 8% and the complication rate was 27% with the majority of complications being minor complications.

Su1605 Anastomotic Leak Following Anterior Resection for Rectal Cancer: Does the Presence of a Defunctioning Stoma Reduce the Burden of a Leak ?

Purpose : Our experience in robotic-assisted rectopexy with sigmoid colon resection (RAR+SR) or without sigmoid colon resection (RAR) was reviewed to determine if there was a significant difference in intra-operative or postoperative outcomes. Methods : We retrospectively reviewed 26 patients that underwent robotic-assisted rectopexy for rectal prolapse from 2006 to 2012. Rectopexy is performed with primary suture pexy and without mesh. Continuous variables were analyzed by t-test, while Fisher's exact test was applied for categorical data. Results : Twenty-two patients underwent RAR and 4 patients underwent RAR+SR. The average age for study participants was 56 years (range 21-78 years) and consisted of 4 men and 22 women. Recurrent rectal prolapse occurred in 2 patients at 3 and 30 months after surgery in the RAR group and no recurrence occurred in the RAR+SR group (p=1.00). The duration of surgery for RAR was 211 minutes versus 309 minutes for RAR+SR (p,0.001, CI 60.8 135.4). Intra-operative blood loss for RAR was 97.8mL compared to 87.5mL for RAR+SR (p=0.924, CI -77.4 89.7). Conversion to open procedure occurred twice with RAR and once with RAR+SR (p=0.407). Length of hospitalization averaged 3 days for RAR and 4 days for RAR+SR (p=0.196, CI -0.2 2.2). The mean follow up was 127 days (range 1-72 months). Eight of 10 patients with preoperative constipation subjectively noted improvement with RAR versus 1 of 2 patients with RAR+SR (p=0.455). Six of 10 patients with preoperative fecal incontinence had subjectively improved symptoms with RAR versus 1 of 2 patients with RAR+SR (p=1.00). Six patients in the RAR group experienced a postoperative complication (over-sedation, corneal abrasion, atrial flutter, pulmonary edema, pelvic hematoma, ileus) versus 1 complication (urinary retention) after RAR+SR (p=0.924). There were no mortalities and no complications requiring operative intervention. Conclusions : The majority of patients underwent RAR and outcomes for RAR versus RAR+SR were not significantly different in this series with the exception of increased operative time for RAR+SR. The recurrence rate was 8% and the complication rate was 27% with the majority of complications being minor complications.

Robot-Assisted vs . Conventional Laparoscopic Rectopexy for Rectal Prolapse: A Comparative Study on Costs and Time

PurposeLaparoscopic rectopexy has become one of the most advocated treatments for full-thickness rectal prolapse, offering good functional results compared with open surgery and resulting in less postoperative pain and faster convalescence. However, laparoscopic rectopexy can be technically demanding. Once having mastered dexterity, with robotic assistance, laparoscopic rectopexy can be performed faster. Moreover, it shortens the learning curve in simple laparoscopic tasks. This may lead to faster and safer laparoscopic surgery. Robot-assisted rectopexy has been proven safe and feasible; however, until now, no study has been performed comparing costs and time consumption in conventional laparoscopic rectopexy vs. robot-assisted rectopexy.MethodsOur first 14 cases of robot-assisted laparoscopic rectopexy were reviewed and compared with 19 patients who underwent conventional laparoscopic rectopexy in the same period.ResultsRobot-assisted laparoscopic rectopexy did not show more complications. However, the average operating time was 39 minutes longer, and costs were -57.29 (or: $745.09) higher.ConclusionRobot-assisted laparoscopic rectopexy is a safe and feasible procedure but results in increased time and higher costs than conventional laparoscopy.

Robotic assisted rectopexy

Background During the last 3 years, robotic surgery has had a considerable impact on minimally invasive surgery in a wide range of specialties. This study describes the surgical technique and preliminary results of our first 6 cases of robotic assisted suture rectopexy. Methods During a period of 13 months 6 patients with full thickness rectal prolapse were operated on with the da Vinci surgical system. All patients were considered suitable for a suture rectopexy. Setting-up time, procedure time, patient recovery, and hospital stay were recorded and compared with the current literature. Results All operations were completed successfully using the robotic system. There were no major complications and no deaths. Mean setting-up time was 28 minutes, mean operation time was 127 minutes, and mean hospital stay was 6 days. At 3 to 6 months of follow-up all patients are in good health, with no signs of recurrence and no reports of constipation. Conclusions Robotic assisted suture rectopexy is feasible and safe and apparently meets accepted standards of laparoscopic surgery.