Robotic Versus Laparoscopic Rectopexy for Complex Rectocele: A Prospective Comparison of Short-Term Outcomes

PURPOSE: The role of robotic assistance in pelvic floor prolapse surgery is debatable. This study aims to report our early experience of robotic-assisted ventral mesh rectopexy in the treatment of complex rectocele and to compare this with the laparoscopic approach in terms of safety and short-term postoperative outcomes. METHODS: We analyzed a cohort of 63 consecutive patients operated on for complex rectocele from March 2008 to December 2009. A complex rectocele was defined as a rectocele that had one or more of the following features: larger than 3 cm in diameter, associated with an enterocele or internal rectal prolapse. The patients underwent either the robotic procedure or laparoscopic procedure, based only on the availability of the robotic system. Procedures involved either a single-mesh fixation for posterior-compartment prolapse (concurrent rectocele and enterocele) or a double-mesh fixation for a concurrent anterior compartment prolapse (with cystocele). A transvaginal tape was inserted at the same surgery in patients with urinary incontinence. RESULTS: All patients were female; 40 underwent the laparoscopic procedure and 23 underwent the robotic procedure. Both groups were similar in age (mean, 59 +/- 13 vs 61 +/- 11; P=.440), ASA status, and previous abdominal surgery, respectively. Patients undergoing the robotic procedure had a significantly higher body mass index (mean, 27 +/- 4 vs 24 +/- 4; P=.03), more frequent double-mesh implantation (17/23 vs 14/40; P=.003), and longer operative time (mean, 221 +/- 39 min vs 162 +/- 60 min; P=.0001). Patients undergoing a laparoscopic procedure had slightly more blood loss (mean, 45 +/- 91mL vs 6 +/- 23 mL, P=.05). The number of transvaginal-tape procedures performed (6/40 vs 3/23, P>.999), conversion rate (10% vs 5%; P=.747), and duration of hospitalization were similar (mean, 5 +/- 2 d vs 5 +/- 1.6 d; P=.872). There were no mortalities or recurrences at the 6-month postoperative review. CONCLUSION: In our experience, the robotic approach for the treatment of complex rectocele is as safe as the laparoscopic approach, with favorable short-term results.