Department of Digestive Surgery, University Hospital of Nancy-Brabois, Vandoeuvre-les-Nancy, France.
Dis Colon Rectum. 2013 Jul;56(7):909-14. doi: 10.1097/DCR.0b013e318289366e.
Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet.
The primary objective of the study was to evaluate long-term functional and anatomic results of robot-assisted laparoscopic rectopexy. The secondary objective was to evaluate the learning curve of this procedure.
Monocentric study data, both preoperative and perioperative, were collected prospectively, and follow-up data were assessed by a telephone questionnaire.
The study was performed in an academic center by 3 different surgeons.
We evaluated all of the consecutive patients who underwent a robot-assisted laparoscopic rectopexy between June 2002 and August 2010.
Rectopexy was performed with 2 anterolateral meshes or with 1 ventral mesh, and in 9 patients a sigmoidectomy was associated with rectopexy.
The actuarial recurrence rate was evaluated using the Kaplan-Meier method.
During the study period, 77 patients underwent a robot-assisted laparoscopic rectopexy, and the mean age was 59.9 years (range, 23-90 y). Average operating time was 223 minutes (range, 100-390 min); the learning curve was completed after 18 patients were seen. Two patients died of causes unrelated to surgery at 5 and 24 months. There were 5 conversions (6%) to open procedure. Overall morbidity was low and concerned only 8 patients (10.4%). Mean follow-up time was 52.5 months (range, 12-115 mo). Recurrences have been observed in 9 patients (12.8%). Preoperatively, 24 (34%) of the patients had constipation. Postoperatively, constipation disappeared for 12 (50%) of 24 and constipation appeared for 11 (24%) of 46 patients. Fecal incontinence decreased after surgery from Wexner score 10.5 to 5.1 of 20.
There was a lack of standardization of the surgical procedure. The study was monocentric. Seven patients (9%) were lost to follow-up.
Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.
机器人辅助腹腔镜直肠固定术治疗完全性直肠脱垂是安全可行的。小系列研究证实了与传统腹腔镜相比，其短期的临床和功能效果相当。目前尚未报道长期结果。
本研究的主要目的是评估机器人辅助腹腔镜直肠固定术的长期功能和解剖结果。次要目的是评估该手术的学习曲线。
前瞻性收集单中心研究数据，包括术前和围手术期数据，并通过电话问卷调查评估随访数据。
该研究由 3 名不同的外科医生在一个学术中心进行。
我们评估了 2002 年 6 月至 2010 年 8 月期间接受机器人辅助腹腔镜直肠固定术的所有连续患者。
直肠固定术采用 2 个前外侧网片或 1 个腹侧网片，9 例患者同时行直肠固定术和乙状结肠切除术。
采用 Kaplan-Meier 法评估累积复发率。
在研究期间，77 例患者接受了机器人辅助腹腔镜直肠固定术，平均年龄为 59.9 岁（范围，23-90 岁）。平均手术时间为 223 分钟（范围，100-390 分钟）；完成 18 例患者后完成学习曲线。2 例患者分别在术后 5 个月和 24 个月因与手术无关的原因死亡。有 5 例（6%）转为开腹手术。总体并发症发生率较低，仅 8 例（10.4%）。平均随访时间为 52.5 个月（范围，12-115 个月）。9 例（12.8%）患者出现复发。术前，24 例（34%）患者有便秘。术后，24 例患者中 12 例（50%）便秘消失，46 例患者中 11 例（24%）便秘出现。Wexner 评分从术前的 10.5 分降至术后的 5.1 分（20 分制）。
手术过程缺乏标准化。该研究为单中心研究。7 例（9%）患者失访。
机器人辅助腹腔镜直肠固定术的长期效果令人满意。需要进一步研究比较机器人辅助腹腔镜和传统腹腔镜，包括成本效益。
