Technical Variations During Robotic Ventral Rectopexy

Document Type

Conference Proceeding

Publication Date

8-2025

Publication Title

Diseases of the Colon and Rectum

Abstract

Purpose/Background: To compile and analyze a diverse set of robotic ventral rectopexy (RVR) videos performed by surgeons experienced with RVR to assess key procedural steps and technical variations.

Methods/Interventions: This International Review Board (IRB)-exempt study analyzed de-identified full-length RVR videos, excluding those involving gynecological procedures. No clinical data or procedure indications were collected. Expert surgeons defined as either RVR fellowship-trained or beyond their learning curve from the United States, Europe and Australia submitted at least one or more unedited videos. Videos were annotated using Frame.ioⓇ by two independent expert reviewers. Each step was defined based on the position of robotic instrumentation ranging from dissection and clearing the sacrum, prosthetic fixation to the rectum, followed by fixation of the prosthesis to the sacrum. Suturing the mesh to the rectum was categorized as distal or middle rectal fixation. Additional steps included creation of peritoneal flaps, anterior (ventral rectal dissection) and excision of the pouch of douglas, fixation of the mesh to the posterior vagina (colpopexy), peritoneal closure, and surgical glue instillation for prosthetic adherence. The mean time spent on each procedural step and the standard deviations were calculated and the sequence of steps were documented.

Results/Outcomes: A total of 21 rectopexy-only videos from 10 international surgeons were analyzed. Procedure steps are outlined in Table I. Steps such as sacral dissection (SD), peritoneal flap (PF), anterior dissection (AD), distal prosthetic fixation (DF), sacral fixation (SF), and peritoneal closure (PC) were performed in all cases. Additional steps like excision of pouch of douglas (EPD), colpopexy (CP), and mid-rectal prosthetic fixation (MF) were selectively performed in 76%, 24%, and 33% of cases, respectively. Of the 10 surgeons queried, 3 routinely performed colpopexy, while 7 reported that they performed it selectively based on preoperative imaging or examination. In 18 videos, the sequence began with sacral dissection and progressed in the similar sequence. In 3 cases, the procedure started with anterior dissection (Fig. 1). Indications for suturing the mid-rectum to the prosthesis was based on surgeon preference as was using surgical glue to augment prosthetic fixation. The majority of operative time was dedicated to AD and DF.

Conclusion/Discussion: Anterior dissection and distal prosthetic fixation accounted for the majority of time spent during RVR among expert surgeons. These steps represent critical areas for focusing technical training for surgical trainees. Future efforts to educate the next generation of RVR surgeons should explore the quality of each procedural step and evaluate decision making for incorporating colpopexy and mid-rectal prosthetic fixation. Further research is needed to correlate specific technical steps with patient functional outcomes and recurrence rates.

Volume

68

Issue

8

First Page

e1585

Comments

American Society of Colon & Rectal Surgeons (ASCRS) Annual Scientific Meeting, May 10-13, 2025, San Diego, CA

Last Page

e1586

DOI

10.1097/DCR.0000000000003863

ISSN

1530-0358

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