title: Robotic versus laparoscopic rectopexy for complex rectocele: a prospective comparison of short-term outcomes.
abstract: OBJECTIVE
  The role of robotic assistance in pelvic floor prolapse surgery is debatable. This study aims to report our early experience of robotic-assisted ventral mesh rectopexy in the treatment of complex rectocele and to compare this with the laparoscopic approach in terms of safety and short-term postoperative outcomes.
  
  
  METHODS
  We analyzed a cohort of 63 consecutive patients operated on for complex rectocele from March 2008 to December 2009. A complex rectocele was defined as a rectocele that had one or more of the following features: larger than 3 cm in diameter, associated with an enterocele or internal rectal prolapse. The patients underwent either the robotic procedure or laparoscopic procedure, based only on the availability of the robotic system. Procedures involved either a single-mesh fixation for posterior-compartment prolapse (concurrent rectocele and enterocele) or a double-mesh fixation for a concurrent anterior compartment prolapse (with cystocele). A transvaginal tape was inserted at the same surgery in patients with urinary incontinence.
  
  
  RESULTS
  All patients were female; 40 underwent the laparoscopic procedure and 23 underwent the robotic procedure. Both groups were similar in age (mean, 59 ± 13 vs 61 ± 11; P = .440), ASA status, and previous abdominal surgery, respectively. Patients undergoing the robotic procedure had a significantly higher body mass index (mean, 27 ± 4 vs 24 ± 4; P = .03), more frequent double-mesh implantation (17/23 vs 14/40; P = .003), and longer operative time (mean, 221 ± 39 min vs 162 ± 60 min; P = .0001). Patients undergoing a laparoscopic procedure had slightly more blood loss (mean, 45 ± 91mL vs 6 ± 23 mL, P = .05). The number of transvaginal-tape procedures performed (6/40 vs 3/23, P > .999), conversion rate (10% vs 5%; P = .747), and duration of hospitalization were similar (mean, 5 ± 2 d vs 5 ± 1.6 d; P = .872). There were no mortalities or recurrences at the 6-month postoperative review.
  
  
  CONCLUSIONS
  In our experience, the robotic approach for the treatment of complex rectocele is as safe as the laparoscopic approach, with favorable short-term results.
authors.affiliation: University Hospital of Nantes Hotel Dieu, Nantes, France.
authors.forename: Mark T C
authors.initials: MT
authors.lastname: Wong
authors.forename: Guillaume
authors.initials: G
authors.lastname: Meurette
authors.forename: Jerome
authors.initials: J
authors.lastname: Rigaud
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regenet
authors.forename: Paul-Antoine
authors.initials: PA
authors.lastname: Lehur
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D020047:Rectocele / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome