Robotic ventral rectopexy: Initial experience in an Indian tertiary health-care centre and review of literature

Abstract

Background:Minimally invasive ventral rectopexy is a well-described technique for management of rectal prolapse. Robotic system has proven its advantage for surgeries in the pelvis. Applying this technique, ventral rectopexy can be done more precisely with minimal recurrence. With growing experience, the operative duration and cost of robotic ventral rectopexy can be reduced with better outcome. Few case studies have been described in literature with no study from Indian subcontinent. We describe a series of eight cases of robotic ventral rectopexy done for rectal prolapse in a tertiary health-care centre of India.Methods:A total of 8 patients were operated for complete rectal prolapse during the period from August 2015 to April 2016. da Vinci Si robotic surgical system was used with prolene or permacol mesh for ventral rectopexy. All patients were prospectively followed for a period minimum of 3 months. Pre- and intra-operative findings were recorded along with post-operative outcome.Results:Out of eight patients, prolene mesh was used in five patients and permacol mesh (porcine collagen) in three patients. Mean operative time (console time) was 177 min and mean total time was 218 min. Mean blood loss was 23.7 ml. Functional outcome was satisfactory in all patients. There was no significant complication in any patient with mean hospital stay of 2.2 days. With average follow-up of 8.8 months, no patient had recurrence.Conclusion:Robotic ventral rectopexy is a safe technique for rectal prolapse with excellent result in terms of functional outcome, recurrence and complications. With experience, the duration and cost can be comparable to laparoscopic technique.

European Society of Coloproctology guidance on the use of mesh in the pelvis in colorectal surgery

“…There were 38 studies reporting the outcome of the use of mesh with rectopexy [13‐51] and one study reporting the outcome of resection suture rectopexy [45]. It was not possible to estimate the effect from pooled data in GRADE evidence due to lack of a comparator in all studies and one non‐mesh study with 0% recurrence.…”

“…The study by Swain et al [46] reported no complications in either group (possibly due to short follow‐up); hence the effect was not estimable. Ogilvie et al [37] reported 28% (8/29) complications in the biological mesh group while that in the synthetic mesh group was 14% (4/29).…”

“…Twenty‐four studies reported whether the peritoneum was closed after rectopexy: two studies showed outcomes of not closing and closing the peritoneum [19,30]. Other studies reported outcomes following closure of the peritoneum [7,9,11,13,14,20,22,27,32,33,34,35,36,37,38,40,43,46,48,49,50,79].…”

“…Twenty‐four studies reported mesh fixation methods: 10 studies used sutures [8,9,15,17,30,36,41,50,51,86] and the remaining studies (14) used ProTack™, spiked chromium or staplers [6,7,13,14,19,20,33,35,40,44,46,48,49,79].…”

Robotic Ventral Mesh Rectopexy: Where do we Stand?

“…7 Similarly, complications of robotic VMR ranged from 0% to 25%, and the majority of them were minor complications. 14,16,18,19,20,21,22,23,24 The largest series of robotic VMR reported a 1.9% intraoperative complication rate, and 1.9% and 7.0% major and minor early postoperative complication rates, respectively. The mortality rate was found to be 0.4%.…”