Background
Minimally invasive ventral rectopexy is a well-described technique for management of rectal prolapse and is being increasingly performed internationally for a definite treatment of rectal prolapse syndromes. Robotic assistance appears advantageous for this procedure and has generally proven its advantage for surgeries in the pelvis particularly the ones related to colorectal diseases. The principal goals of a ventral rectopexy procedure are to restore normal anatomy and to re-establish 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.
Advantages of Robotic Ventral Rectopexy in India
ventral rectopexy can be done more precisely along with minimal recurrence. The advantage and simplicity of ventral rectopexy served in lowering the chance of damage to pelvic nerves, and this is because the dissection in the traditional rectopexy procedure can cause secondary autonomic nerve damage. whereas in ventral rectopexy the anterior dissection serves in avoiding postoperative constipation leading to better functional outcomes.
Disadvantages of Robotic Ventral Rectopexy in India
The main Limitation of robotic rectopexy is the higher costs and operative time related to the robot expenses itself along with its maintenance costs. But on the other hand; Studies and research has shown that the console time and total operation time decreases with experience using the robot. for Robotic Rectal Prolapse Repair In India
Procedure
The procedure involves attachment of the perineal body and the anterior rectum to the anterior longitudinal ligament of the sacrum;
- A nova grasp device is used to retract the sigmoid colon to the left lateral pelvic sidewall
- The perineum lateral to the rectum is incised
- The peritoneal incision is lengthened. This dissection is performed with a mono polar curve scissor and carried anterior to the rectum and vagina.; The rectal vaginal septum is developed sharply. This procedure involves to mobilization posterior to the rectum.
- A piece of SurgiMend mesh is trimmed to size and placed in the abdomen and sutured to the most distal part of rectum using interrupted 2.0 Ti-Cron sutures.
- The mesh then fixated to the to the sacral promontory using interrupted sutures
- The mesh is tested to ensure appropriate tension.
- Finally, the peritoneum is closed over the mesh using a continuous V-Loc suture. for Robotic Rectal Prolapse Repair In India
Conclusion
Robotic ventral rectopexy is a safe technique for rectal prolapse with excellent result in terms of functional outcome, recurrence and complications. It can be adopted easily in a centre with established laparoscopy unit. With experience, the duration and cost can be comparable to laparoscopic technique. In addition, with growing experience, the operative duration and cost of robotic ventral rectopexy can be reduced with better outcome.
In conclusion, due to the increased use of robotics for colorectal surgeries associated with satisfying outcomes; robotic rectopexy has become an applicable and established option for the management of complete rectal prolapse. for Robotic Rectal Prolapse Repair In India