Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

Tommaso Simoncini¹, Andrea Panattoni², Mustafa Aktas³, Jozef Ampe⁴, Cornelia Betschart⁵, Alexander L A Bloemendaal⁶, Stephan Buse⁷, Giuseppe Campagna⁸, Marta Caretto², Mauro Cervigni⁹, Esther C J Consten¹⁰, Hugo H Davila¹¹, Jean Dubuisson¹², Eloy Espin-Basany¹³, Bernardina Fabiani¹⁴, Jean-Luc Faucheron¹⁵, Andrea Giannini², Brooke Gurland¹⁶, Dieter Hahnloser¹⁷, Ralf Joukhadar¹⁸, Paolo Mannella², Liliana Mereu¹⁹, Jacopo Martellucci²⁰, Guillaume Meurette²¹, Maria Magdalena Montt Guevara², Carlo Ratto²², Barry A O'Reilly²³, Christl Reisenauer²⁴, Eleonora Russo², Steven Schraffordt Koops²⁵, Shahab Siddiqi²⁶, Alessandro Sturiale¹⁴, Gabriele Naldini¹⁴

Affiliations

¹ Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. tommaso.simoncini@unipi.it.
² Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³ Division of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands.
⁴ Department of Urology, AZ Sint-Jan Bruges Hospitals, Brugge, Belgium.
⁵ Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands.
⁷ Department of Urology and Urologic Oncology, Alfried Krupp Hospital, Essen, Germany.
⁸ Division of Urogynecology and Pelvic Floor Reconstructive Surgery, Department of Women and Child Health, University Hospital A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
⁹ Department of Urology, La Sapienza University-Polo Pontino ICOT, Latina, Italy.
¹⁰ Department of Surgery, Meander Medical Center, Amersfoort and Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
¹¹ Cleveland Clinic Indian River Hospital, Florida State University, College of Medicine, Tallahassee, FL, USA.
¹² Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
¹³ Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
¹⁴ Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy.
¹⁵ Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France.
¹⁶ Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
¹⁷ Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
¹⁸ Department of Obstetrics and Gynecology, University of Wuerzburg, Würzburg, Germany.
¹⁹ Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy.
²⁰ Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy.
²¹ Digestive and Endocrine Surgery Clinic, IMAD, CHU de Nantes, Hôtel Dieu, Nantes Cedex, France.
²² Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland.
²⁴ Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany.
²⁵ Department of Gynecology, Meander Medical Center, Amersfoort, The Netherlands.
²⁶ Broomfield Hospital, Court Road, Chelmsford, UK.

PMID: 36952046
PMCID: PMC10035464
DOI: 10.1007/s00464-023-10001-4

Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

Tommaso Simoncini et al. Surg Endosc. 2023 Jul.

. 2023 Jul;37(7):5215-5225.

doi: 10.1007/s00464-023-10001-4. Epub 2023 Mar 23.

Authors

Affiliations

¹ Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. tommaso.simoncini@unipi.it.
² Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³ Division of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands.
⁴ Department of Urology, AZ Sint-Jan Bruges Hospitals, Brugge, Belgium.
⁵ Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
⁶ Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands.
⁷ Department of Urology and Urologic Oncology, Alfried Krupp Hospital, Essen, Germany.
⁸ Division of Urogynecology and Pelvic Floor Reconstructive Surgery, Department of Women and Child Health, University Hospital A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
⁹ Department of Urology, La Sapienza University-Polo Pontino ICOT, Latina, Italy.
¹⁰ Department of Surgery, Meander Medical Center, Amersfoort and Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
¹¹ Cleveland Clinic Indian River Hospital, Florida State University, College of Medicine, Tallahassee, FL, USA.
¹² Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
¹³ Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
¹⁴ Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy.
¹⁵ Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France.
¹⁶ Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
¹⁷ Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.
¹⁸ Department of Obstetrics and Gynecology, University of Wuerzburg, Würzburg, Germany.
¹⁹ Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy.
²⁰ Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy.
²¹ Digestive and Endocrine Surgery Clinic, IMAD, CHU de Nantes, Hôtel Dieu, Nantes Cedex, France.
²² Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
²³ Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland.
²⁴ Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany.
²⁵ Department of Gynecology, Meander Medical Center, Amersfoort, The Netherlands.
²⁶ Broomfield Hospital, Court Road, Chelmsford, UK.

PMID: 36952046
PMCID: PMC10035464
DOI: 10.1007/s00464-023-10001-4

Abstract

Background: Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was to address the proper role of robotic pelvic floor reconstructive procedures using expert opinion.

Methods: We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons' characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis.

Results: The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy.

Conclusion: Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.

Keywords: Delphi consensus; Pelvic floor reconstructive surgery; Pelvic organ prolapse; Rectal prolapse; Robotic surgery.

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Conflict of interest statement

Alexander L.A. Bloemendaal is proctor and speaker for Intuitive Surgical, TelaBio, and FascioTens. Stephan Buse is proctor for Intuitive Surgical. Ralf Joukhadar is proctor and speaker for Intuitive Surgical. Christl Reisenauer received speaker’s honoraria from Intuitive Surgical, Contura/Axonics, and Boston Scientific. Tommaso Simoncini has received consulting fees from Abbott, Astellas, Gedeon Richter, Mitsubishi Tanabe, Sojournix, Estetra, Mithra, Actavis, Medtronic, Shionogi, and Applied Medical and has received speakers’ honoraria from Shionogi, Gedeon Richter, Intuitive Surgical, Applied Medical, and Theramex. Steven Schraffordt Koops is proctor for Intuitive Surgical. Andrea Panattoni, Mustafa Aktas, Jozef Ampe, Cornelia Betschart, Alexander L.A. Bloemendaal, Giuseppe Campagna, Marta Caretto, Mauro Cervigni, Esther C.J. Consten, Hugo H. Davila, Jean Dubuisson, Eloy Espin-Basany, Bernardina Fabiani, Jean-Luc Faucheron, Andrea Giannini, Brooke Gurland, Dieter Hahnloser, Paolo Mannella, Liliana Mereu, Jacopo Martellucci, Guillaume Meurette, Maria Magdalena Montt Guevara, Carlo Ratto, Barry A. O'Reilly, Eleonora Russo, Shahab Siddiqi, Alessandro Sturiale, and Gabriele Naldini have no conflicts of interest or financial ties to disclose.

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Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

Affiliations

Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users

Authors

Affiliations

Abstract

Conflict of interest statement

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