title: Robot-assisted or conventional laparoscoic rectopexy for rectal prolapse? Systematic review and meta-analysis.
abstract: OBJECTIVE
  The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated.
  
  
  METHODS
  A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR).
  
  
  RESULTS
  Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete.
  
  
  CONCLUSIONS
  The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
authors.affiliation: "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy. Electronic address: rondellif@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Rondelli
authors.affiliation: "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy. Electronic address: walterbugiantella@alice.it.
authors.forename: W
authors.initials: W
authors.lastname: Bugiantella
authors.affiliation: "Bellinzona e Valli" Regional Hospital, 6500, Bellinzona, Switzerland. Electronic address: fabio.villa@eoc.ch.
authors.forename: F
authors.initials: F
authors.lastname: Villa
authors.affiliation: General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy. Electronic address: sanguinettiale@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy. Electronic address: bonimarce@tiscali.it.
authors.forename: M
authors.initials: M
authors.lastname: Boni
authors.affiliation: "San Giovanni Battista" Hospital, General Surgery, USL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy. Electronic address: enrico.mariani@uslumbria2.it.
authors.forename: E
authors.initials: E
authors.lastname: Mariani
authors.affiliation: University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: N
authors.initials: N
authors.lastname: Avenia
mesh_terms: D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D012005:Rectal Prolapse / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: Laparoscopy; Meta-analysis; Rectal prolapse; Rectopexy; Robot assisted; Robotic