Robotic versus laparoscopic ventral mesh rectopexy: a systematic review and meta-analysis

• Published in: International journal of colorectal disease Vol. 36; no. 8; pp. 1621 - 1631
• Main Authors: Flynn, Julie, Larach, Jose T., Kong, Joseph C. H., Warrier, Satish K., Heriot, Alexander
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2021; Springer; Springer Nature B.V
• Subjects: Analysis; Gastroenterology; Hepatology; Humans; Internal Medicine; Laparoscopic surgery; Laparoscopy; Length of stay; Medicine; Medicine & Public Health; Meta-analysis; Pelvis; Proctology; Quality of Life; Rectal Prolapse - surgery; Rectum; Review; Robotic surgery; Robotic Surgical Procedures; Statistical analysis; Surgery; Surgical Mesh; Treatment Outcome; Robotic surgery; Ventral mesh rectopexy; Rectal prolapse; Colorectal surgery
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-021-03904-y

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.