Mäkelä-Kaikkonen J, Rautio T, Pääkkö E, Biancari F, Ohtonen P, Mäkelä J
Department of Surgery, Oulu University Hospital, Oulu, Finland.
Department of Radiology, Oulu University Hospital, Oulu, Finland.
Colorectal Dis. 2016 Oct;18(10):1010-1015. doi: 10.1111/codi.13309.
The purpose of this prospective randomized study was to compare robot-assisted and laparoscopic ventral rectopexy procedures for posterior compartment procidentia in terms of restoration of the anatomy using magnetic resonance (MR) defaecography.
Sixteen female patients (four with total prolapse, twelve with intussusception) underwent robot-assisted ventral mesh rectopexy (RVMR) and 14 female patients (two with prolapse, twelve with intussusception) laparoscopic ventral mesh rectopexy (LVMR). Primary outcome measures were perioperative parameters, complications and restoration of anatomy as assessed by MR defaecography, which was performed preoperatively and 3 months after surgery.
Patient demographics, operation length, operating theatre times and length of in-hospital stay were similar between the groups. The anatomical defects of rectal prolapse, intussusception and rectocele and enterocele were similarly corrected after rectopexy in either technique as confirmed with dynamic MR defaecography. A slight residual intussusception was observed in three patients with primary total prolapse (two RVMR vs one LVMR) and in one patient with primary intussusception (RVMR) (P = 0.60). Rectocele was reduced from a mean of 33.0 ± 14.9 mm to 5.5 ± 8.4 mm after RVMR (P < 0.001) and from 24.7 ± 17.5 mm to 7.2 ± 3.2 mm after LVMR (P < 0.001) (RVMR vs LVMR, P = 0.10).
Robot-assisted laparoscopic ventral rectopexy can be performed safely and within the same operative time as conventional laparoscopy. Minimally invasive ventral rectopexy allows good anatomical correction as assessed by MR defaecography, with no differences between the techniques.
本前瞻性随机研究旨在通过磁共振（MR）排粪造影比较机器人辅助和腹腔镜腹侧直肠固定术治疗后盆腔脏器脱垂在解剖结构恢复方面的效果。
16例女性患者（4例完全脱垂，12例套叠）接受机器人辅助腹侧网状直肠固定术（RVMR），14例女性患者（2例脱垂，12例套叠）接受腹腔镜腹侧网状直肠固定术（LVMR）。主要观察指标为围手术期参数、并发症以及通过术前和术后3个月进行的MR排粪造影评估的解剖结构恢复情况。
两组患者的人口统计学特征、手术时长、手术室停留时间和住院时间相似。动态MR排粪造影证实，两种技术在直肠固定术后对直肠脱垂、套叠、直肠膨出和肠膨出的解剖缺陷的纠正效果相似。3例原发性完全脱垂患者（2例RVMR vs 1例LVMR）和1例原发性套叠患者（RVMR）观察到轻微残留套叠（P = 0.60）。RVMR后直肠膨出平均从33.0±14.9mm降至5.5±8.4mm（P < 0.001），LVMR后从24.7±17.5mm降至7.2±3.2mm（P < 0.001）（RVMR vs LVMR，P = 0.10）。
机器人辅助腹腔镜腹侧直肠固定术可安全进行，且手术时间与传统腹腔镜手术相同。微创腹侧直肠固定术通过MR排粪造影评估可实现良好的解剖结构纠正，两种技术之间无差异。
