Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Tech Coloproctol. 2023 Jul;27(7):551-557. doi: 10.1007/s10151-023-02756-8. Epub 2023 Feb 18.
Robot-assisted ventral mesh rectopexy is considered a valid option in the treatment of rectal prolapse. However, it involves higher costs than the laparoscopic approach. The aim of this study is to determine if less expensive robotic surgery for rectal prolapse can be safely performed.
This study was conducted on consecutive patients who underwent robot-assisted ventral mesh rectopexy at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, from 7 November 2020 to 22 November 2021. The cost of hospitalization, surgical procedure, robotic materials, and operating room resources in patients undergoing robot-assisted ventral mesh rectopexy with the da Vinci Xi Surgical Systems was analyzed before and after technical modifications, including the reduction of robotic arms and instruments, and the execution of a double minimal peritoneal incision at the pouch of Douglas and sacral promontory (instead of the traditional inverted J incision).
Twenty-two robot-assisted ventral mesh rectopexies were performed [21 females, 95.5%, median age 62.0 (54.8-70.0) years]. After an initial experience performing traditional robot-assisted ventral mesh rectopexy in four patients, we adopted technical modifications in other cases. No major complication or conversion to open surgery occurred. In total, mean cost of hospitalization, surgical procedure, robotic materials, and operating room resources was €6995.5 ± 1058.0, €5912.7 ± 877.0, €2797.6 ± 545.6, and €2608.3 ± 351.5, respectively. Technical modifications allowed a significant reduction in the overall cost of hospitalization (€6604.5 ± 589.5 versus €8755.0 ± 906.4, p = 0.001), number of robotic instruments (3.1 ± 0.2 versus 4.0 ± 0.8 units, p = 0.026), and operating room time (201 ± 26 versus 253 ± 16 min, p = 0.003).
Considering our preliminary results, robot-assisted ventral mesh rectopexy with appropriate technical modifications can be cost-effective and safe.
机器人辅助腹侧网片直肠固定术被认为是直肠脱垂治疗的有效选择。然而，它比腹腔镜方法的成本更高。本研究的目的是确定更便宜的机器人手术是否可以安全地用于直肠脱垂。
本研究连续纳入 2020 年 11 月 7 日至 2021 年 11 月 22 日在罗马的 Fondazione Policlinico Universitario"A. Gemelli"IRCCS 接受机器人辅助腹侧网片直肠固定术的患者。分析达芬奇 Xi 手术系统行机器人辅助腹侧网片直肠固定术的住院费用、手术过程、机器人耗材和手术室资源，包括减少机器人手臂和器械，以及在Douglas 袋和荐骨岬（而不是传统的倒置 J 切口）进行双最小腹膜切口。
共完成 22 例机器人辅助腹侧网片直肠固定术[21 例女性，95.5%，中位年龄 62.0（54.8-70.0）岁]。在最初的 4 例患者中进行了传统机器人辅助腹侧网片直肠固定术的经验后，我们在其他病例中采用了技术修改。无重大并发症或转为开放手术。总的来说，平均住院费用、手术过程、机器人耗材和手术室资源分别为€6995.5±1058.0、€5912.7±877.0、€2797.6±545.6 和 €2608.3±351.5。技术修改显著降低了总住院费用（€6604.5±589.5 与 €8755.0±906.4，p=0.001）、机器人器械数量（3.1±0.2 与 4.0±0.8 个单位，p=0.026）和手术室时间（201±26 与 253±16 分钟，p=0.003）。
考虑到我们的初步结果，具有适当技术修改的机器人辅助腹侧网片直肠固定术可以具有成本效益和安全性。
