Robot-assisted laparoscopic rectovaginopexy for rectal prolapse: a prospective cohort study on feasibility and safety

Abstract

Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse, however, are scarce. This prospective cohort study evaluated the outcome of this technique up to one year after surgery. From January 2005 to June 2006, 15 consecutive patients with a rectal prolapse, either with or without a concomitant rectocele or enterocele, underwent robot-assisted laparoscopic rectovaginopexy with support of the da Vinci robotic system. A prospective cohort study was performed on operating times, blood loss, intra-operative and post-operative complications, and outcome at a minimum of one year after surgery. Median age at time of operation was 62 years (33-72) and median body mass index 24.9 (20.9-33.9). Median robot set-up time was 10 min (3-15) and median skin-to-skin operating time was 160 min (120-180). No conversions to open surgery were necessary. No in-hospital complications occurred and there was no mortality. Median hospital stay was four days (2-9). During one year follow-up, two patients needed surgical reintervention. One patient was operated for recurrent enterocele and rectocele one week after surgery. In another patient an incisional hernia at the camera port occurred three months after surgery. At one year after surgery, 87% of patients claimed to be satisfied with their postoperative result. Robot-assisted laparoscopic rectovaginopexy proved to be an effective technique with favourable outcomes in most patients in this prospective series. The operating team experienced the support of the robotic system as beneficial, especially during the dissection of the rectovaginal plane and suturing in the Douglas pouch.

Keywords: Laparoscopy; Rectal prolapse; Rectopexy; Rectovaginopexy; Robot; Robotic surgery.

Fig. 1

Positioning of the robotic camera port, 8-mm robotic instrument ports, and standard laparoscopic assistance ports for robot-assisted rectovaginopexy

Fig. 2

Set up and positioning of the operating team in relation to the ports and robotic cart in robot-assisted laparoscopic rectovaginopexy for rectal prolapse. A, anaesthetic equipment, RA, robotic instrument arm, CA, camera arm, M, video cart (with monitor, insufflator, ultrasonic dissection generator, light source, camera unit, and focus control and synchronizer), A, table-side assistant, N, scrub nurse, C, robotic console, and S, surgeon

Fig. 3

Technique of rectovaginopexy