Julie Flynn1,2,3, Jose T Larach4,5,6, Joseph C H Kong5,7,8, Satish K Warrier5,7,8, Alexander Heriot5,7,8. 1. Department of Surgery, Epworth Healthcare, Bridge Rd, Richmond, 3121, Australia. Jafly1@gmail.com. 2. Division of Cancer Surgery, University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia. Jafly1@gmail.com. 3. University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia. Jafly1@gmail.com. 4. Department of Surgery, Epworth Healthcare, Bridge Rd, Richmond, 3121, Australia. 5. Division of Cancer Surgery, University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia. 6. Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile. 7. University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia. 8. Division of Cancer Research, University of Melbourne, Sir Peter MacCallum Cancer Centre, Melbourne, Australia.
Abstract
INTRODUCTION: Ventral mesh rectopexy is frequently performed as a means of improving the quality of life for sufferers of rectal prolapse. The minimally invasive approach is highly desirable but can be technically difficult to achieve in the narrow confines of the pelvis. The robotic platform is becoming a more common means of overcoming these difficulties, but evidence of an objective benefit over standard laparoscopy is scarce. This study seeks to review and analyse the data comparing outcomes after robotic and laparoscopic ventral mesh rectopexy. METHOD: We searched MEDLINE, EMBASE and the Cochrane database for papers comparing robotic to laparoscopic ventral mesh rectopexy. Comparable data was pooled for meta-analysis. RESULTS: Six studies compared outcomes between robotic and laparoscopic ventral mesh rectopexy. Sample sizes were relatively small, and only two of the studies were randomised. Pooled analysis was possible for data on operating time, complication rates, conversion rates and length of stay in hospital. This showed a non-significant trend towards longer operating times and a statistically significant reduction in length of stay after robotic procedures. There was no significant difference in complication and conversion rates. CONCLUSION: The frequent finding of longer operating time for robotic surgery was not confirmed in this study. Shorter length of stay in hospital was seen, with other post-operative outcomes showing no significant difference. More data is needed with cost-benefit analyses to show whether the robotic platform is justified.
INTRODUCTION: Ventral mesh rectopexy is frequently performed as a means of improving the quality of life for sufferers of rectal prolapse. The minimally invasive approach is highly desirable but can be technically difficult to achieve in the narrow confines of the pelvis. The robotic platform is becoming a more common means of overcoming these difficulties, but evidence of an objective benefit over standard laparoscopy is scarce. This study seeks to review and analyse the data comparing outcomes after robotic and laparoscopic ventral mesh rectopexy. METHOD: We searched MEDLINE, EMBASE and the Cochrane database for papers comparing robotic to laparoscopic ventral mesh rectopexy. Comparable data was pooled for meta-analysis. RESULTS: Six studies compared outcomes between robotic and laparoscopic ventral mesh rectopexy. Sample sizes were relatively small, and only two of the studies were randomised. Pooled analysis was possible for data on operating time, complication rates, conversion rates and length of stay in hospital. This showed a non-significant trend towards longer operating times and a statistically significant reduction in length of stay after robotic procedures. There was no significant difference in complication and conversion rates. CONCLUSION: The frequent finding of longer operating time for robotic surgery was not confirmed in this study. Shorter length of stay in hospital was seen, with other post-operative outcomes showing no significant difference. More data is needed with cost-benefit analyses to show whether the robotic platform is justified.
Authors: Jonathan A C Sterne; Jelena Savović; Matthew J Page; Roy G Elbers; Natalie S Blencowe; Isabelle Boutron; Christopher J Cates; Hung-Yuan Cheng; Mark S Corbett; Sandra M Eldridge; Jonathan R Emberson; Miguel A Hernán; Sally Hopewell; Asbjørn Hróbjartsson; Daniela R Junqueira; Peter Jüni; Jamie J Kirkham; Toby Lasserson; Tianjing Li; Alexandra McAleenan; Barnaby C Reeves; Sasha Shepperd; Ian Shrier; Lesley A Stewart; Kate Tilling; Ian R White; Penny F Whiting; Julian P T Higgins Journal: BMJ Date: 2019-08-28
Authors: J Mäkelä-Kaikkonen; T Rautio; K Klintrup; H Takala; M Vierimaa; P Ohtonen; J Mäkelä Journal: Tech Coloproctol Date: 2013-07-10 Impact factor: 3.781
Authors: Johanna K Mäkelä-Kaikkonen; Tero T Rautio; Sari Koivurova; Eija Pääkkö; Pasi Ohtonen; Fausto Biancari; Jyrki T Mäkelä Journal: Int Urogynecol J Date: 2016-06-01 Impact factor: 2.894
Authors: J Mäkelä-Kaikkonen; T Rautio; A Ohinmaa; S Koivurova; P Ohtonen; H Sintonen; J Mäkelä Journal: Tech Coloproctol Date: 2019-05-08 Impact factor: 3.781