Techniques in Coloproctology

, Volume 23, Issue 6, pp 529–535 | Cite as

Robotic vs. laparoscopic ventral mesh rectopexy for external rectal prolapse and rectal intussusception: a systematic review

  • S. Albayati
  • P. Chen
  • M. J. Morgan
  • J. W. T. Toh



Laparoscopic ventral mesh rectopexy (LVR) is a treatment with promising results in external rectal prolapse, rectal intussusception, and rectocele. Because of the emergence of robotic-assisted surgery and the technical advantage it provides, we examined the potential role and place of robotic surgery in ventral rectopexy.


MEDLINE, PubMed, and other databases were searched, by two independent reviewers, to identify studies comparing robotic to laparoscopic ventral mesh rectopexy. The primary outcome was the rate of unplanned conversion to open. The secondary outcomes were morbidity, length of hospital stay and recurrence rate.


Five studies (4% male, n = 259) met the inclusion criteria. All 5 studies reported on conversion rate and showed no significant difference between the conversion rate of robotic and laparoscopic groups [OR 0.58 (95% CI 0.09–3.77)]. Robotic surgery was also similar to laparoscopic surgery for both morbidity [OR 0.71 (95% CI 0.34–1.48)] and recurrence rate [OR 0.56 (95% CI 0.18–1.75)]. Operative time was longer in the robotic group with a MWD of 22.88 minutes (CI 5.73–40.04, p < 0.0007). There was a statistically significant reduction in length of stay with robotic surgery [mean difference − 0.36 days (95% CI − 0.66 to − 0.07)].


This systematic review shows that robotic-assisted ventral rectopexy requires longer operative time with no significant added benefit over laparoscopic ventral rectopexy. The conversion rate was low in both groups and the trends to benefit did not reach statistical significance. More studies are required to clarify whether the potential technical advantage of robotic surgery in ventral rectopexy translates to an improvement in clinical outcome.


Rectal prolapse Ventral mesh rectopexy Robotic surgery Laparoscopic surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Jayne D et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR Randomized Clinical Trial. JAMA 318(16):1569–1580CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ramage L et al (2015) Is robotic ventral mesh rectopexy better than laparoscopy in the treatment of rectal prolapse and obstructed defecation? A meta-analysis. Tech Coloproctol 19(7):381–389CrossRefGoogle Scholar
  3. 3.
    de Hoog DE et al (2009) Recurrence and functional results after open versus conventional laparoscopic versus robot-assisted laparoscopic rectopexy for rectal prolapse: a case-control study. Int J Colorectal Dis 24(10):1201–1206CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Heemskerk J et al (2007) Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 50(11):1825–1830CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Faucheron JL et al (2016) Day case robotic ventral rectopexy compared with day case laparoscopic ventral rectopexy: a prospective study. Tech Coloproctol 20(10):695–700CrossRefPubMedGoogle Scholar
  6. 6.
    Makela-Kaikkonen J et al (2016) Robot-assisted versus laparoscopic ventral rectopexy for external, internal rectal prolapse and enterocele: a randomised controlled trial. Colorectal Dis 18(10):1010–1015CrossRefPubMedGoogle Scholar
  7. 7.
    Shamseer L et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349:g7647CrossRefGoogle Scholar
  8. 8.
    Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605CrossRefPubMedGoogle Scholar
  9. 9.
    Mehmood RK et al (2014) Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior? Int J Colorectal Dis 29(9):1113–1118CrossRefGoogle Scholar
  10. 10.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1471–2288 (Electronic)):13CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Makela-Kaikkonen J et al (2014) Robotic-assisted and laparoscopic ventral rectopexy in the treatment of rectal prolapse: a matched-pairs study of operative details and complications. Tech Coloproctol 18(2):151–155CrossRefPubMedGoogle Scholar
  12. 12.
    Mantoo S et al (2013) Is robotic-assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation? Colorectal Dis 15(8):e469–e475CrossRefPubMedGoogle Scholar
  13. 13.
    D’Hoore A, Penninckx F (2006) Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc 20(12):1919–1923CrossRefGoogle Scholar
  14. 14.
    Rondelli F et al (2014) Robot-assisted or conventional laparoscopic rectopexy for rectal prolapse? Systematic review and meta-analysis. Int J Surg 12:S153–S159CrossRefPubMedGoogle Scholar
  15. 15.
    Prete FP et al (2018) Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 267(6):1034–1046CrossRefPubMedGoogle Scholar
  16. 16.
    Bhama AR et al (2016) A comparison of laparoscopic and robotic colorectal surgery outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Surg Endosc 30(4):1576–1584CrossRefPubMedGoogle Scholar
  17. 17.
    Mercer-Jones MA, Brown SR, Knowles CH, Williams AB (2017) Position statement by the pelvic floor society on behalf of the association of coloproctology of Great Britain and Ireland on the use of mesh in ventral mesh rectopexy (VMR). Colorectal Dis. CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryBankstown-Lidcombe HospitalSydneyAustralia
  2. 2.South Western Sydney Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.Department of SurgeryWestmead HospitalSydneyAustralia
  4. 4.Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyAustralia
  5. 5.MoorebankAustralia

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