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Dumas C, Duclos J, Le Huu Nho R, Fermo M, Gomez E, Henin A, Vaisse C, Pirro N, Aubert M, Mege D. Is robotic ventral mesh rectopexy for pelvic floor disorders better than laparoscopic approach at the beginning of the experience? A retrospective single-center study. Int J Colorectal Dis 2023; 38:216. [PMID: 37589810 DOI: 10.1007/s00384-023-04511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To compare perioperative results of laparoscopic and robotic ventral mesh rectopexy for pelvic floor disorders at the beginning of the surgical experience. METHODS Between 2017 and 2022, the first 30 laparoscopic ventral mesh rectopexies and the first 30 robotic ventral mesh rectopexies at the beginning of the experience of 2 surgeons were retrospectively analyzed. Perioperative (demographic characteristics, surgical indication, conversion rate, operative time), and postoperative (complications, length of stay, unplanned reintervention) data were compared between groups. RESULTS Demographic characteristics were similar between groups. Conversion rate was lower (0 vs 17%, p = 0.05), but the operative time was significantly longer (182 [146-290] vs 150 [75-240] minutes, p < 0.0001) during robotic procedure when compared with laparoscopic approach. In terms of learning curve, the number of procedures to obtain the same operative time between the 2 approaches was 15. Postoperative results were similar between groups, in terms of pain (visual analogic scale = 2 [0-8] vs 4 [0-9], p = 0.07), morbidity (17 vs 3%, p = 0.2), and unplanned reintervention (1 vs 0%, p = 0.99). Mean length of stay was significantly reduced after robotic approach when compared with laparoscopic approach (3 [2-10] vs 5 [2-11] days, p < 0.01). Functional results were better after robotic than laparoscopic ventral mesh rectopexy, with higher satisfaction rate (93 vs 75%, p = 0.05), and reduced recurrence rate (0 vs 14%, p = 0.048). CONCLUSION Despite longer operative time at the beginning of the learning curve, robotic ventral mesh rectopexy was associated with similar or better perioperative results than laparoscopic ventral mesh rectopexy.
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Affiliation(s)
- Clotylde Dumas
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Julie Duclos
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Rémy Le Huu Nho
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Magali Fermo
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Emilie Gomez
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Aurélia Henin
- Department of Intensive Care and Anesthesiology Department 2, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Camille Vaisse
- Department of Intensive Care and Anesthesiology Department 2, Timone Hospital, Aix Marseille Univ, APHM, Marseille, France
| | - Nicolas Pirro
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Mathilde Aubert
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Diane Mege
- Department of Digestive Surgery, Timone Hospital, Aix Marseille Univ, APHM, 264 rue Saint-Pierre, 13005, Marseille, France.
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Oruc M, Erol T. Current diagnostic tools and treatment modalities for rectal prolapse. World J Clin Cases 2023; 11:3680-3693. [PMID: 37383136 PMCID: PMC10294152 DOI: 10.12998/wjcc.v11.i16.3680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general population. Multiple treatment modalities have been described, which have changed significantly over time. Particularly in the last decade, laparoscopic and robotic surgical approaches with different mobilization techniques, combined with medical therapies, have been widely implemented. Because patients have presented with a wide range of complaints (ranging from abdominal discomfort to incomplete bowel evacuation, mucus discharge, constipation, diarrhea, and fecal incontinence), understanding the extent of complaints and ruling out differential diagnoses are essential for choosing a tailored surgical procedure. It is crucial to assess these additional symptoms and their severities using preoperative scoring systems. Additionally, radiological and physiological evaluations may explain some vague symptoms and reveal concomitant pelvic disorders. However, there is no consensus on or standardization of the optimal extent of dissection, type of procedure, and materials used for rectal fixation; this makes providing maximum benefits to patients with minimal complications difficult. Even recent publications and systematic reviews have not recommended the most appropriate treatment options. This review explains the appropriate diagnostic tools for different conditions and summarizes the current treatment approaches based on existing literature and expert opinions.
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Affiliation(s)
- Mustafa Oruc
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
| | - Timucin Erol
- Department of General Surgery, Hacettepe University School of Medicine, Ankara 06100, Turkey
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Simoncini T, Panattoni A, Aktas M, Ampe J, Betschart C, Bloemendaal ALA, Buse S, Campagna G, Caretto M, Cervigni M, Consten ECJ, Davila HH, Dubuisson J, Espin-Basany E, Fabiani B, Faucheron JL, Giannini A, Gurland B, Hahnloser D, Joukhadar R, Mannella P, Mereu L, Martellucci J, Meurette G, Montt Guevara MM, Ratto C, O'Reilly BA, Reisenauer C, Russo E, Schraffordt Koops S, Siddiqi S, Sturiale A, Naldini G. Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users. Surg Endosc 2023:10.1007/s00464-023-10001-4. [PMID: 36952046 PMCID: PMC10035464 DOI: 10.1007/s00464-023-10001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
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.
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Affiliation(s)
- Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Andrea Panattoni
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mustafa Aktas
- Division of Obstetrics and Gynecology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jozef Ampe
- Department of Urology, AZ Sint-Jan Bruges Hospitals, Brugge, Belgium
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Stephan Buse
- Department of Urology and Urologic Oncology, Alfried Krupp Hospital, Essen, Germany
| | - Giuseppe Campagna
- 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
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mauro Cervigni
- Department of Urology, La Sapienza University-Polo Pontino ICOT, Latina, Italy
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort and Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Hugo H Davila
- Cleveland Clinic Indian River Hospital, Florida State University, College of Medicine, Tallahassee, FL, USA
| | - Jean Dubuisson
- Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eloy Espin-Basany
- Unidad de Cirugía Colorrectal, Servicio de Cirugía General, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Bernardina Fabiani
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
| | - Jean-Luc Faucheron
- Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, Grenoble Alps University Hospital, Grenoble, France
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Brooke Gurland
- Division of Colorectal Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Ralf Joukhadar
- Department of Obstetrics and Gynecology, University of Wuerzburg, Würzburg, Germany
| | - Paolo Mannella
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Mereu
- Department of Obstetrics and Gynecology, Cannizzaro Hospital, Catania, Italy
| | - Jacopo Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - Guillaume Meurette
- Digestive and Endocrine Surgery Clinic, IMAD, CHU de Nantes, Hôtel Dieu, Nantes Cedex, France
| | - Maria Magdalena Montt Guevara
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Ratto
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Barry A O'Reilly
- Department of Obstetrics and Gynecology, Cork University Maternity Hospital, Cork, Ireland
| | - Christl Reisenauer
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Center, Cisanello University Hospital, Pisa, Italy
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Marra AA, Campennì P, De Simone V, Parello A, Litta F, Ratto C. Technical modifications for cost optimization in robot-assisted ventral mesh rectopexy: an initial experience. Tech Coloproctol 2023:10.1007/s10151-023-02756-8. [PMID: 36802041 PMCID: PMC9938509 DOI: 10.1007/s10151-023-02756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Robot-assisted ventral mesh rectopexy is considered a valid option in the treatment of rectal prolapse. However, it involves higher costs than the laparoscopic approach. The aim of this study is to determine if less expensive robotic surgery for rectal prolapse can be safely performed. METHODS This study was conducted on consecutive patients who underwent robot-assisted ventral mesh rectopexy at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, from 7 November 2020 to 22 November 2021. The cost of hospitalization, surgical procedure, robotic materials, and operating room resources in patients undergoing robot-assisted ventral mesh rectopexy with the da Vinci Xi Surgical Systems was analyzed before and after technical modifications, including the reduction of robotic arms and instruments, and the execution of a double minimal peritoneal incision at the pouch of Douglas and sacral promontory (instead of the traditional inverted J incision). RESULTS Twenty-two robot-assisted ventral mesh rectopexies were performed [21 females, 95.5%, median age 62.0 (54.8-70.0) years]. After an initial experience performing traditional robot-assisted ventral mesh rectopexy in four patients, we adopted technical modifications in other cases. No major complication or conversion to open surgery occurred. In total, mean cost of hospitalization, surgical procedure, robotic materials, and operating room resources was €6995.5 ± 1058.0, €5912.7 ± 877.0, €2797.6 ± 545.6, and €2608.3 ± 351.5, respectively. Technical modifications allowed a significant reduction in the overall cost of hospitalization (€6604.5 ± 589.5 versus €8755.0 ± 906.4, p = 0.001), number of robotic instruments (3.1 ± 0.2 versus 4.0 ± 0.8 units, p = 0.026), and operating room time (201 ± 26 versus 253 ± 16 min, p = 0.003). CONCLUSIONS Considering our preliminary results, robot-assisted ventral mesh rectopexy with appropriate technical modifications can be cost-effective and safe.
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Affiliation(s)
- A. A. Marra
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - P. Campennì
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - V. De Simone
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - A. Parello
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - F. Litta
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy
| | - C. Ratto
- Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy ,Università Cattolica del Sacro Cuore, Rome, Italy
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Using a modified Delphi process to explore international surgeon-reported benefits of robotic-assisted surgery to perform abdominal rectopexy. Tech Coloproctol 2022; 26:953-962. [DOI: 10.1007/s10151-022-02679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
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Mid-term functional and quality of life outcomes of robotic and laparoscopic ventral mesh rectopexy: multicenter comparative matched-pair analyses. Tech Coloproctol 2021; 26:253-260. [PMID: 34935090 PMCID: PMC8917003 DOI: 10.1007/s10151-021-02563-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
Background The aim of this study was to compare patients’ mid-term functional and quality of life (QoL) outcomes following robotic ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR). Methods The data of consecutive female patients who underwent minimally invasive ventral mesh rectopexy for external or symptomatic internal rectal prolapse at 3 hospitals in Finland between January 2011 and December 2016 were retrospectively collected. Patients were matched by age and diagnosis at a 1:1 ratio. A disease-related symptom questionnaire was sent to all living patients at follow-up in July 2018. Results After a total of 401 patients (RVMR, n = 187; LVMR, n = 214) were matched, 152 patients in each group were included in the final analyses. The median follow-up times were 3.3 (range 1.6–7.4) years and 3.0 (range 1.6–7.6) years for the RVMR and LVMR groups, respectively. The postoperative QoL measures did not differ between the groups. Compared with the LVMR group, the RVMR group had lower postoperative Wexner Incontinence Score (median 5 vs. median 8; p < 0.001), experienced significant ongoing incontinence symptoms less often (30.6% vs. 49.0%; p < 0.001) and reported less postoperative faecal incontinence discomfort evaluated with the visual analogue scale (median 11 vs. median 39; p = 0.005). RVMR patients had a shorter hospital stay (2.2 days vs. 3.8 days; p < 0.001) but experienced more frequent de novo pelvic pain (31.8% vs. 11.8%; p < 0.001). Conclusion RVMR and LVMR patients had equal functional and QoL outcomes. Those who underwent RVMR had lower mid-term anal incontinence symptom scores but suffered more frequent de novo pelvic pain. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-021-02563-z.
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Robotic versus laparoscopic ventral mesh rectopexy: a systematic review and meta-analysis. Int J Colorectal Dis 2021; 36:1621-1631. [PMID: 33718972 DOI: 10.1007/s00384-021-03904-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ventral mesh rectopexy is frequently performed as a means of improving the quality of life for sufferers of rectal prolapse. The minimally invasive approach is highly desirable but can be technically difficult to achieve in the narrow confines of the pelvis. The robotic platform is becoming a more common means of overcoming these difficulties, but evidence of an objective benefit over standard laparoscopy is scarce. This study seeks to review and analyse the data comparing outcomes after robotic and laparoscopic ventral mesh rectopexy. METHOD We searched MEDLINE, EMBASE and the Cochrane database for papers comparing robotic to laparoscopic ventral mesh rectopexy. Comparable data was pooled for meta-analysis. RESULTS Six studies compared outcomes between robotic and laparoscopic ventral mesh rectopexy. Sample sizes were relatively small, and only two of the studies were randomised. Pooled analysis was possible for data on operating time, complication rates, conversion rates and length of stay in hospital. This showed a non-significant trend towards longer operating times and a statistically significant reduction in length of stay after robotic procedures. There was no significant difference in complication and conversion rates. CONCLUSION The frequent finding of longer operating time for robotic surgery was not confirmed in this study. Shorter length of stay in hospital was seen, with other post-operative outcomes showing no significant difference. More data is needed with cost-benefit analyses to show whether the robotic platform is justified.
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Same-Day Discharge After Minimally Invasive Sacrocolpopexy Is Feasible, Safe, and Associated With High Patient Satisfaction. Female Pelvic Med Reconstr Surg 2021; 27:e614-e619. [PMID: 33411456 DOI: 10.1097/spv.0000000000000998] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to compare the incidence of adverse events and postoperative health care resource utilization, as well as to determine satisfaction in patients after a same-day discharge (SDD) protocol compared with routine care (discharge ≥postoperative day 1). METHODS This is a prospective cohort study of SDD after minimally invasive sacrocolpopexy. Eligibility criteria included age younger than 80 years, American Society of Anesthesiologists grade I/II, caretaker for ≥24 hours postoperatively, and surgical start before 1 pm. Perioperative data were obtained through the medical record and direct patient inquiry. A satisfaction survey was administered at the postoperative visit. A historical control group was used to compare outcomes. RESULTS Forty-seven women met the eligibility criteria. Mean age was 62 (±9) years. Most were White (95.7%), were overweight (body mass index, 27.7 ± 5.5 kg/m2), and had stage 3 prolapse (63.8%). Same-day discharge was achieved for 37 patients (78.7%). Patient characteristics of the SDD cohort were similar to the routine-care cohort, with the exception of previous hysterectomy (57.5% vs 100.0%, P < 0.001) and the American Society of Anesthesiologists score (2 [1-2] vs 2 [1-3], P = 0.002). There were significantly fewer postoperative telephone calls in the SDD cohort but no other differences in health care resource utilization. Adverse events did not differ between groups. The SDD cohort reported high satisfaction and would recommend SDD to family or friends independent of whether or not SDD was achieved (91.9% vs 80.0%, P = 0.29). CONCLUSIONS Nearly 80% of women undergoing minimally invasive sacrocolpopexy on an SDD protocol went home as planned. Compared with routine care, there was no increase in adverse events or postoperative health care resource utilization. Patient satisfaction in the SDD cohort was high. CLINICAL TRIAL REGISTRATION Same-day discharge after minimally invasive sacrocolpopexy, https://clinicaltrials.gov/ct2/show/NCT03730103?term=same+day+discharge&cntry=US&state=US%3AOH&city=Cleveland&draw=2&rank=1; NCT03730103.
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Bao X, Wang H, Song W, Chen Y, Luo Y. Meta-analysis on current status, efficacy, and safety of laparoscopic and robotic ventral mesh rectopexy for rectal prolapse treatment: can robotic surgery become the gold standard? Int J Colorectal Dis 2021; 36:1685-1694. [PMID: 33646353 DOI: 10.1007/s00384-021-03885-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Robotic-assisted surgery and robotic-assisted ventral mesh rectopexy are gaining attention in the treatment of rectal prolapse and increased positive findings are proposed. The objective of this meta-analysis was to investigate whether robotic-assisted ventral mesh rectopexy is comparable with the conventional laparoscopic approach surgery. METHODS Five major databases (PubMed, Sciencedirect, Web of Science, Embase, and Cochrane Library) were searched for eligible studies. Observational studies of the effect and safety of robotic-assisted and laparoscopic approaches on ventral mesh rectopexy were included. Odd ratios (OR) and weight mean difference (WMD) were used for dichotomous data and continuous data analysis. Clinical outcomes, functional outcomes, and cost-effectiveness data were extracted for meta-analysis. RESULTS Compared to the laparoscopic approach, a significant shorter length of hospital stay (LOS), lesser intraoperative blood loss, and lower post-operative complication rate of RVMR group were observed. However, operation time of RVMR was significant increased. The expense of RVMR was higher than LVMR; mean Wexner scores and fecal incontinence were lower in RVMR group while there were no statistical differences. CONCLUSION The result of the current analysis revealed that the robotic-assisted ventral mesh rectopexy is effective and feasible in the treatment of rectal prolapse. However, long-term follow-up and results are needed for the promotion of this approach. There is a long way for robotic-assisted surgery to become a gold standard in rectal surgery.
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Affiliation(s)
- Xu Bao
- Department of General Surgery, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin Third Center Hospital, No.83, Jintang Road, Hedong District, Tianjin, 300170, China.
| | - Huan Wang
- School of nursing, Tianjin Medical University, No.22, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Weiliang Song
- Department of General Surgery, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin Third Center Hospital, No.83, Jintang Road, Hedong District, Tianjin, 300170, China
| | - Yuzhuo Chen
- Department of General Surgery, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin Third Center Hospital, No.83, Jintang Road, Hedong District, Tianjin, 300170, China
| | - Ying Luo
- Institute of Hepatobiliary Disease, Tianjin Third Center Hospital, No.83, Jintang Road, Hedong District, Tianjin, 300170, China
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Pisani Ceretti A, Opocher E, Bianchi PP. Update on Robotic Rectal Prolapse Treatment. J Pers Med 2021; 11:706. [PMID: 34442349 PMCID: PMC8399170 DOI: 10.3390/jpm11080706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates.
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Affiliation(s)
- Giampaolo Formisano
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Adelona Salaj
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Simona Giuratrabocchetta
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
| | - Andrea Pisani Ceretti
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Enrico Opocher
- Division of General and HPB Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (A.P.C.); (E.O.)
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milano, Italy; (G.F.); (A.S.); (S.G.); (P.P.B.)
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Yamamoto T, Hyakudomi R, Takai K, Taniura T, Uchida Y, Ishitobi K, Hirahara N, Tajima Y. Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report. World J Clin Cases 2021; 9:847-853. [PMID: 33585631 PMCID: PMC7852635 DOI: 10.12998/wjcc.v9.i4.847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.
CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse.
CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
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Affiliation(s)
- Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kiyoe Takai
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
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Vuagniaux A, Gié O, Butti F, Marques-Vidal PM, Demartines N, Mantziari S. Preoperative Clinical Factors Associated with Short-Stay Laparoscopic Appendectomy. World J Surg 2019; 43:2771-2778. [PMID: 31407096 DOI: 10.1007/s00268-019-05115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Outpatient appendectomy for acute appendicitis is a feasible, yet not widely performed procedure, as there are no universally accepted criteria for patient selection. The aim of this study was to assess preoperative clinical factors associated with successful short-stay appendectomy (SSA) and establish a predictive score to help with patient selection. METHODS All consecutive laparoscopic appendectomies performed in our institution between January 2013 and June 2015 were retrospectively analyzed. Several preoperative clinical and biological variables were compared between patients with SSA, defined as a postoperative stay <24 h, and those needing inpatient care. Logistic regression analysis was used to identify variables independently associated with SSA, and these variables were then used to create a predictive score. RESULTS A total of 578 patients were included, 303 (53%) in the SSA group and 275 (48%) in the long-stay appendectomy (LSA) group. In multivariate analysis, male gender (OR 1.61, 95% CI 1.12-2.31, p = 0.010), ASA class I-II (OR 9.52, 95% CI 1.65-180.69, p = 0.037), absence of generalized guarding (OR 3.55, 95% CI 1.30-11.41, p = 0.019), C-reactive protein <100 mg/dl (OR 3.09, 95% CI 1.81-5.42, p < 0.001) and leukocyte count <20 g/l (OR 2.06, 95% CI 1.02-4.30, p = 0.046) were independently associated with SSA. These five parameters were used to construct a predictive score, whereby ≥17 (range 0-21) was defined as the optimal threshold to predict SSA with a high sensitivity (95.6%) and negative predictive value (82.2%). CONCLUSIONS A purely clinical predictive score based on five widely used preoperative parameters can be used to identify eligible patients for short-stay appendectomy.
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Affiliation(s)
- Aurélie Vuagniaux
- Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Gié
- Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Fabio Butti
- Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pedro Manuel Marques-Vidal
- Department of Internal Medicine, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery and Transplantation, Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University UNIL, Lausanne, Switzerland
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13
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Faucheron JL, Trilling B, Girard E. Robotic ventral mesh rectopexy for rectal prolapse: a few years until this becomes the gold standard. Tech Coloproctol 2019; 23:407-409. [PMID: 31273485 DOI: 10.1007/s10151-019-02016-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- J-L Faucheron
- Colorectal Unit, Department of Surgery, Michallon University Hospital, CS 10217, 38043, Grenoble cedex, France. .,University Grenoble Alpes, Grenoble, France.
| | - B Trilling
- Colorectal Unit, Department of Surgery, Michallon University Hospital, CS 10217, 38043, Grenoble cedex, France.,University Grenoble Alpes, Grenoble, France
| | - E Girard
- Colorectal Unit, Department of Surgery, Michallon University Hospital, CS 10217, 38043, Grenoble cedex, France.,University Grenoble Alpes, Grenoble, France
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14
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Albayati S, Chen P, Morgan MJ, Toh JWT. Robotic vs. laparoscopic ventral mesh rectopexy for external rectal prolapse and rectal intussusception: a systematic review. Tech Coloproctol 2019; 23:529-535. [PMID: 31254202 DOI: 10.1007/s10151-019-02014-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic ventral mesh rectopexy (LVR) is a treatment with promising results in external rectal prolapse, rectal intussusception, and rectocele. Because of the emergence of robotic-assisted surgery and the technical advantage it provides, we examined the potential role and place of robotic surgery in ventral rectopexy. METHODS MEDLINE, PubMed, and other databases were searched, by two independent reviewers, to identify studies comparing robotic to laparoscopic ventral mesh rectopexy. The primary outcome was the rate of unplanned conversion to open. The secondary outcomes were morbidity, length of hospital stay and recurrence rate. RESULTS Five studies (4% male, n = 259) met the inclusion criteria. All 5 studies reported on conversion rate and showed no significant difference between the conversion rate of robotic and laparoscopic groups [OR 0.58 (95% CI 0.09-3.77)]. Robotic surgery was also similar to laparoscopic surgery for both morbidity [OR 0.71 (95% CI 0.34-1.48)] and recurrence rate [OR 0.56 (95% CI 0.18-1.75)]. Operative time was longer in the robotic group with a MWD of 22.88 minutes (CI 5.73-40.04, p < 0.0007). There was a statistically significant reduction in length of stay with robotic surgery [mean difference - 0.36 days (95% CI - 0.66 to - 0.07)]. CONCLUSIONS This systematic review shows that robotic-assisted ventral rectopexy requires longer operative time with no significant added benefit over laparoscopic ventral rectopexy. The conversion rate was low in both groups and the trends to benefit did not reach statistical significance. More studies are required to clarify whether the potential technical advantage of robotic surgery in ventral rectopexy translates to an improvement in clinical outcome.
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Affiliation(s)
- S Albayati
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia.
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.
- , Moorebank, Australia.
| | - P Chen
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
| | - M J Morgan
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - J W T Toh
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
- Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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15
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Postillon A, Perrenot C, Germain A, Scherrer ML, Buisset C, Brunaud L, Ayav A, Bresler L. Long-term outcomes of robotic ventral mesh rectopexy for external rectal prolapse. Surg Endosc 2019; 34:930-939. [PMID: 31183789 DOI: 10.1007/s00464-019-06851-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/18/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Nowadays in Europe, laparoscopic ventral mesh rectopexy is the gold standard treatment of external rectal prolapse (ERP). The benefits of robot ventral mesh rectopexy (RVMR) are not clearly defined. The primary objective of the study was to evaluate the long-term results of RVMR. The secondary objective was to determine predictive factors of recurrence. DESIGN Monocentric, retrospective study. Data, both pre-operative and peri-operative, were collected, and follow-up data were assessed prospectively by a telephone questionnaire. The study was performed in a tertiary referral center. METHODS Between August 2007 and August 2017, we evaluate all consecutive patients who underwent RVMR for ERP by three different surgeons. The primary outcome was the recurrence rate perceived by patients. Secondary outcome were functional results based on Knowles-Eccersley-Scott-Symptom score for constipation and Wexner score for incontinence, compared before and after surgery. RESULTS During the study period 96 patients (86 women) underwent RVMR. The mean age was 62.3 years (range 16-90). Twelve patients had a history of ERP repair. Sixty-nine patients were analyzed for long-term outcomes with a mean follow-up of 37 months (range 2.3-92 months). Recurrence rate was 12.5%. After surgery, constipation was significantly reduced: 44 patients were constipated before surgery versus 23 after surgery. Six patients described de novo constipation (6.25%). Fecal incontinence was significantly reduced: 59 patients were incontinent before surgery versus 14 after surgery. No predictive factor for recurrence was identified after multivariate analysis. No mesh related complications were related. CONCLUSIONS In conclusion, RVMR presents good long-term functional result and a recurrence rate similar to LVMR as published in the literature. The rate of mesh related complications seems lower.
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Affiliation(s)
- Agathe Postillon
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France.
| | - Cyril Perrenot
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Adeline Germain
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Marie-Lorraine Scherrer
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Cyrille Buisset
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Laurent Brunaud
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Ahmet Ayav
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
| | - Laurent Bresler
- Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France
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16
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Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse: a randomized trial. Tech Coloproctol 2019; 23:461-470. [PMID: 31069557 PMCID: PMC6620369 DOI: 10.1007/s10151-019-01991-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/15/2019] [Indexed: 12/15/2022]
Abstract
Background 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. Methods A 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. Results There 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). Conclusions Although 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.
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17
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Abstract
PURPOSE OF REVIEW Despite the growth in laparoscopic surgery, comparable oncological outcomes, and reduced complication rates, the majority of colorectal surgery is still performed via an open approach. Reasons for this may include technical difficulties associated with operating in narrow spaces such as in the pelvis and inadequate experience. Robotic surgery provides potential solutions to some of these challenges. This review will summarize the state of the literature regarding robotic colorectal surgery. RECENT FINDINGS The most consistent benefit of robotic surgery is decreasing operative conversions, specifically in rectal cancer. In partial colectomies, there is evidence to support quicker return to bowel function. Oncologic outcomes compared to the laparoscopic approach are equivalent. Robotic surgery provides solutions to the challenges posed by laparoscopy, including wristed instruments, ease of intracorporeal suturing, and ergonomic advantages. Randomized trials to evaluate peri-operative outcomes will be important. If robotics is able to facilitate conversion of open colectomies to their minimally invasive equivalent, robotics may end up proving to be advantageous in the peri-operative and post-operative period. Continued studies are warranted.
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Affiliation(s)
- Harith H Mushtaq
- General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.331, Houston, TX, 77030, USA
| | - Shinil K Shah
- Minimally Invasive and Elective General Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Amit K Agarwal
- Colon and Rectal Surgery, McGovern Medical School at UT Health, 6431 Fannin Street, MSB 4.158, Houston, TX, 77030, USA.
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18
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Trompetto M, Tutino R, Realis Luc A, Novelli E, Gallo G, Clerico G. Altemeier's procedure for complete rectal prolapse; outcome and function in 43 consecutive female patients. BMC Surg 2019; 19:1. [PMID: 30606166 PMCID: PMC6318906 DOI: 10.1186/s12893-018-0463-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this retrospective study was to evaluate morbidity, mortality, postoperative function and recurrences in patients treated by Altemeier’s rectosigmoidectomy for complete rectal prolapse in a referral center for pelvic floor functional disorders. Methods Peri-operative data on 43 consecutive female patients were reviewed. At follow-up any change in pelvic floor function and recurrences were determined. Thirty four patients were assessed at a median interval of 49 (2–135) months, six being deceased for reason not related to the prolapse and three lost to follow-up. Results Post-operative complications at 30 days occurred in 18 patients (38%). Major complication occurred in only one patient that was pneumonia with lung failure. Major complications were not related to the ASA score, BMI or age [average age 76.4]. There was no post-operative mortality at 30 days. At long-term follow-up functional results demonstrate a statistically significant decrease in the Obstructive Defecation Syndrome (ODS) score, but no statistically significant changes in the Vaizey score, the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) score and the urinary retention score. ODS score decreased with respect to levatorplasty and the change was statistically significant instead of Vaizey score in which were not. At the same follow-up there were 12 (35%) cases of recurrence with an estimated risk at 48 months of 40%. There were no statistically significant differences between patients with and without recurrence regarding age (p = 0.188), BMI (p = 0.864), ASA score (p = 0.433), previously repaired prolapse (p = 0.398), previous hysterectomy (p = 0.705), length of resected bowel (p = 0.126), and levatorplasty (p = 0.304). Patient satisfaction showed a mean of 8.8 and 6.4 respectively in patients without and with recurrences (p = 0.012). Conclusions Altemeier’s procedure had in our series low complications rate and no mortality. It offered improved evacuation in constipated patients while didn’t improve fecal and urinary continence. Recurrence of prolapse was 40% at four years. Electronic supplementary material The online version of this article (10.1186/s12893-018-0463-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mario Trompetto
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
| | - Roberta Tutino
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy. .,Dept. of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | | | - Eugenio Novelli
- Department of Biostatistics, S.Gaudenzio Clinic, Policlinico di Monza, Italy
| | - Gaetano Gallo
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy.,Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Clerico
- Department of Colorectal Surgery. S Rita Clinic, Vercelli, Italy
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19
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Affiliation(s)
- Naveen Kumar
- Anatomy Fellow, Queen Mary University of London, London, UK
| | - Devinder Kumar
- Professor of Gastrointestinal Surgery, St George’s University of London, London, UK
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20
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21
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Comment on "What Expert Surgeons Never Tell You About Robot-assisted Surgery for Rectal Cancer?". Ann Surg 2018; 270:e10-e11. [PMID: 30048326 DOI: 10.1097/sla.0000000000002986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Videodefecography is still superior to magnetic resonance defecography in the study of obstructed defecation syndrome. Tech Coloproctol 2018; 22:321-322. [DOI: 10.1007/s10151-018-1748-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
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23
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Inaba CS, Sujatha-Bhaskar S, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A. Robotic ventral mesh rectopexy for rectal prolapse: a single-institution experience. Tech Coloproctol 2017; 21:667-671. [PMID: 28871416 DOI: 10.1007/s10151-017-1675-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic ventral mesh rectopexy (RVMR) is an appealing approach for the treatment of rectal prolapse and other conditions. The aim of this study was to evaluate the outcomes of RVMR for rectal prolapse. METHODS We performed a retrospective chart review for patients who underwent RVMR for rectal prolapse at our institution between July 2012 and May 2016. Any patient who underwent RVMR during this time frame was included in our analysis. Any cases involving colorectal resection or other rectopexy techniques were excluded. RESULTS Of the 24 patients who underwent RVMR, 95.8% of patients were female. Median age was 67.5 years old (IQR 51.5-73.3), and 79.2% of patients were American Society of Anesthesiologists class III or IV. Median operative time was 191 min (IQR 164.3-242.5), and median length of stay was 3 days (IQR 2-3). There were no conversions, RVMR-related complications or mortality. Patients were followed for a median of 3.8 (IQR 1.2-15.9) months. Full-thickness recurrence occurred in 3 (12.4%) patients. Rates of fecal incontinence improved after surgery (62.5 vs. 41.5%, respectively) as did constipation (45.8 vs. 33.3%, respectively). No patients reported worsening symptoms postoperatively. Only one (4.2%) patient reported de novo constipation postoperatively. CONCLUSIONS RVMR is a feasible, safe and effective option for the treatment of rectal prolapse, with low short-term morbidity and mortality. Multicenter and long-term studies are needed to better assess the benefits of this procedure.
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Affiliation(s)
- C S Inaba
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - S Sujatha-Bhaskar
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - C Y Koh
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - M D Jafari
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - S D Mills
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - J C Carmichael
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - M J Stamos
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA
| | - A Pigazzi
- Department of Colorectal Surgery, University of California Irvine Medical Center, Orange, CA, USA.
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