title: Robot-assisted vs laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial.
abstract: OBJECTIVE
  The purpose of this prospective randomized study was to compare robot-assisted and laparoscopic ventral rectopexy procedures for posterior compartment procidentia in terms of restoration of the anatomy using magnetic resonance (MR) defaecography.
  
  
  METHODS
  Sixteen female patients (four with total prolapse, twelve with intussusception) underwent robot-assisted ventral mesh rectopexy (RVMR) and 14 female patients (two with prolapse, twelve with intussusception) laparoscopic ventral mesh rectopexy (LVMR). Primary outcome measures were perioperative parameters, complications and restoration of anatomy as assessed by MR defaecography, which was performed preoperatively and 3 months after surgery.
  
  
  RESULTS
  Patient demographics, operation length, operating theatre times and length of in-hospital stay were similar between the groups. The anatomical defects of rectal prolapse, intussusception and rectocele and enterocele were similarly corrected after rectopexy in either technique as confirmed with dynamic MR defaecography. A slight residual intussusception was observed in three patients with primary total prolapse (two RVMR vs one LVMR) and in one patient with primary intussusception (RVMR) (P = 0.60). Rectocele was reduced from a mean of 33.0 ± 14.9 mm to 5.5 ± 8.4 mm after RVMR (P < 0.001) and from 24.7 ± 17.5 mm to 7.2 ± 3.2 mm after LVMR (P < 0.001) (RVMR vs LVMR, P = 0.10).
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic ventral rectopexy can be performed safely and within the same operative time as conventional laparoscopy. Minimally invasive ventral rectopexy allows good anatomical correction as assessed by MR defaecography, with no differences between the techniques.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. johanna.makela-kaikkonen@ppshp.fi.
authors.forename: J
authors.initials: J
authors.lastname: Mäkelä-Kaikkonen
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Rautio
authors.affiliation: Department of Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Pääkkö
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: F
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Mäkelä
mesh_terms: D000368:Aged; D019841:Defecography / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000473:pathology / Q000601:surgery*; D020047:Rectocele / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Laparoscopic surgery; MR defaecography; intussusception; rectal prolapse; rectopexy; robotic surgery