Anatomical and functional changes to the pelvic floor after robotic versus laparoscopic ventral rectopexy: a randomised study

• Published in: International Urogynecology Journal Vol. 27; no. 12; pp. 1837 - 1845
• Main Authors: Mäkelä-Kaikkonen, Johanna K., Rautio, Tero T., Koivurova, Sari, Pääkkö, Eija, Ohtonen, Pasi, Biancari, Fausto, Mäkelä, Jyrki T.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.12.2016; Springer Nature B.V
• Subjects: Aged; Defecography; Female; Gynecologic Surgical Procedures - statistics & numerical data; Gynecology; Humans; Laparoscopy - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Original Article; Rectal Prolapse - surgery; Robotic Surgical Procedures - statistics & numerical data; Treatment Outcome; Urology; POP-Q; Pelvic organ mobility; Ventral rectopexy; Magnetic resonance defecography; Pelvic floor dysfunction; Robot-assisted procedure
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-016-3048-y

Introduction and hypothesis 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. Conclusion 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.