Da Vinci Robotic Ventral Rectopexy: A New Technique for a Well Known Problem

Tiffany T Fancher, MD, David L Walters, MD FACS FASCR. St. Francis Medical Center

Introduction: The incidence of pelvic floor dysfunction is rapidly increasing and the repair techniques are evolving. One standard procedure in the treatement of rectal prolapse and complicated rectoceles is a rectopexy. The dissection in the rectopexy procedure can cause secondary autonomic nerve damage; the advantage of a ventral rectopexy is the anterior dissection avoids postoperative constipation. Reports have shown that the robotic approach is safe and feasible for rectal prolapse. This study is the first report of the Da Vinci robotic approach for the ventral rectopexy procedure (DVVR) used solely for a complicated rectocele or rectal prolapse.

Methods and Procedures: After Institutional Review Board approval, a retrospective chart review was performed of all women who underwent DVVR by a single surgeon from May 2011 to October 2011. The procedure involves attachment of the perineal body and the anterior rectum to the anterior longitudinal ligament of the sacrum using a Restorelle Y Empathy mesh. Data analyzed included demographics, presenting symptoms, medical co-morbidities, past surgical histories, operative time, estimated blood loss, intra-operative complications, length of hospital stay, 30-day readmission rate and post-operative complications occurring within 6 weeks of surgery. A full clinical examination was performed prior to surgery and during each follow-up visit.

Results: Nine women underwent DVVR for their rectal prolapse and/or rectocele. The mean age of the subjects was 57 years (range 44–75). The majority of women presented with symptoms of a rectal bulge and defecatory dysfunction. There were no conversions to conventional laparoscopy or laparotomy. There were no intra-operative complications including visceral injury, hemorrhage requiring transfusion or infection requiring intravenous antibiotics. Eight of the patients went home on the first post-operative day; 1 patient (who had concomitant cystocele repair was discharged on the second post-operative day after resolution of urinary retention. None of the women were readmitted within 30 days of their original surgery. At the postoperative appointment, all women reported subjective satisfaction with their postoperative course and results; on examination there was no evidence of rectal prolapse and/or rectocele.

Conclusion: The principal goals of a ventral rectopexy procedure are to restore normal anatomy and to reestablish normal defecatory and sexual function. The minimally invasive approach to the surgical management of pelvic organ prolapse is a technically challenging procedure, requiring careful dissection, preservation of vital structures and suturing deep in the pelvis. Robotic assistance in such a procedure seems like a natural extension of its current applications and we present the first case series, and favorable outcomes following robotic ventral rectopexy to treat rectal prolapse and/or rectocele.
 

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