title: Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study.
abstract: OBJECTIVE
  To compare the effect of laparoscopic and robot-assisted ventral rectopexy for posterior compartment procidentia on the pelvic floor anatomy and function.
  
  
  METHODS
  A prospective randomised single-centre study was carried out of 29 female patients, who underwent robot-assisted or laparoscopic ventral mesh rectopexy for external or internal rectal prolapse with symptoms of obstructive defecation and/or faecal incontinence. Anatomical changes were measured by Pelvic Organ Prolapse Quantification (POP-Q) and magnetic resonance defecography. Functional changes were evaluated using symptom questionnaires before and 3 months after surgery.
  
  
  RESULTS
  After rectopexy, changes in POP-Q measurements were statistically significant for points Ap, Bp, C, D and Ba. The descent of the anorectum and cervix/vaginal cuff during straining were significantly reduced with regard to the reference line (mean, -10.4 ± 14.9 mm, p = 0.001) and (-13.3 ± 18.1 mm, p < 0.001) respectively. Pelvic organ mobility (POM) was reduced statistically significantly for the posterior (mean, -16.6 ± 20.8 mm, p < 0.001) and apical compartments (mean, -13.1 ± 14.8, p < 0.001). The PFDI-20, PFIQ-7 and PISQ-12 questionnaires showed statistically significant improvement of symptoms and sexual function. No significant differences were observed between the robot-assisted and laparoscopic techniques in terms of anatomical or functional parameters.
  
  
  CONCLUSIONS
  Ventral mesh recto-colpo-sacropexy effectively corrects the anatomy of the posterior compartment, elevates the vaginal apex and reduces pelvic organ mobility of the posterior and middle compartments. The robot-assisted and laparoscopic techniques had similar anatomical and functional outcomes.
authors.affiliation: Department of Surgery, Division of Gastroenterological Surgery, Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland. johanna.makela-kaikkonen@ppshp.fi.|Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland. johanna.makela-kaikkonen@ppshp.fi.
authors.forename: Johanna K
authors.initials: JK
authors.lastname: Mäkelä-Kaikkonen
authors.affiliation: Department of Surgery, Division of Gastroenterological Surgery, Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland.|Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Tero T
authors.initials: TT
authors.lastname: Rautio
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Koivurova
authors.affiliation: Department of Radiology, University Hospital of Oulu, Oulu, Finland.
authors.forename: Eija
authors.initials: E
authors.lastname: Pääkkö
authors.affiliation: Department of Surgery, Division of Gastroenterological Surgery, Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland.|Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Department of Surgery, Division of Gastroenterological Surgery, Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland.|Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Surgery, Division of Gastroenterological Surgery, Oulu University Hospital, PL 21, 90029 OYS, Oulu, Finland.|Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland.
authors.forename: Jyrki T
authors.initials: JT
authors.lastname: Mäkelä
mesh_terms: D000368:Aged; D019841:Defecography; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D012005:Rectal Prolapse / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Magnetic resonance defecography; POP-Q; Pelvic floor dysfunction; Pelvic organ mobility; Robot-assisted procedure; Ventral rectopexy