title: Long-term outcomes of robot-assisted laparoscopic rectopexy for rectal prolapse.
abstract: BACKGROUND
  Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet.
  
  
  OBJECTIVE
  The primary objective of the study was to evaluate long-term functional and anatomic results of robot-assisted laparoscopic rectopexy. The secondary objective was to evaluate the learning curve of this procedure.
  
  
  METHODS
  Monocentric study data, both preoperative and perioperative, were collected prospectively, and follow-up data were assessed by a telephone questionnaire.
  
  
  METHODS
  The study was performed in an academic center by 3 different surgeons.
  
  
  METHODS
  We evaluated all of the consecutive patients who underwent a robot-assisted laparoscopic rectopexy between June 2002 and August 2010.
  
  
  METHODS
  Rectopexy was performed with 2 anterolateral meshes or with 1 ventral mesh, and in 9 patients a sigmoidectomy was associated with rectopexy.
  
  
  METHODS
  The actuarial recurrence rate was evaluated using the Kaplan-Meier method.
  
  
  RESULTS
  During the study period, 77 patients underwent a robot-assisted laparoscopic rectopexy, and the mean age was 59.9 years (range, 23-90 y). Average operating time was 223 minutes (range, 100-390 min); the learning curve was completed after 18 patients were seen. Two patients died of causes unrelated to surgery at 5 and 24 months. There were 5 conversions (6%) to open procedure. Overall morbidity was low and concerned only 8 patients (10.4%). Mean follow-up time was 52.5 months (range, 12-115 mo). Recurrences have been observed in 9 patients (12.8%). Preoperatively, 24 (34%) of the patients had constipation. Postoperatively, constipation disappeared for 12 (50%) of 24 and constipation appeared for 11 (24%) of 46 patients. Fecal incontinence decreased after surgery from Wexner score 10.5 to 5.1 of 20.
  
  
  CONCLUSIONS
  There was a lack of standardization of the surgical procedure. The study was monocentric. Seven patients (9%) were lost to follow-up.
  
  
  CONCLUSIONS
  Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.
authors.affiliation: Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Perrenot
authors.forename: Adeline
authors.initials: A
authors.lastname: Germain
authors.forename: Marie-Lorraine
authors.initials: ML
authors.lastname: Scherrer
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ayav
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012005:Rectal Prolapse / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult