Robotic-assisted versus conventional laparoscopic rectopexy for rectal prolapse: a single-center cohort study

Background Minimally invasive techniques have become the standard of care for treating rectal prolapse through a transabdominal approach. However, there is limited data comparing the laparoscopic and robotic approaches in terms of long-term recurrence and reoperation rate. This study aimed at comparing the perioperative and long-term outcomes of robotic-assisted rectopexy versus conventional laparoscopic rectopexy in patients treated for rectal prolapse. Methods This retrospective single-center cohort study included consecutive patients who underwent rectopexy at the University Hospitals Geneva between 2013 and 2023. Patients were categorized into laparoscopic and robotic approaches. Demographics, perioperative outcomes and long-term recurrence rate were analyzed. Results One hundred and ninety patients were considered for inclusion. After exclusion of recurrent cases and cases with synchronous interventions, 157 patients were included in the present analysis. Of those, 130 underwent laparoscopic rectopexy, whereas 27 patients benefited from robotic rectopexy. Baseline characteristics, including age, gender, and ASA score, were comparable between groups. Patients in the robotic group were more likely to undergo mesh implantation (96.3% vs. 72.3%, p = 0.006). Operative times were significantly longer in the robotic group (150 ± 55 vs. 120 ± 51 minutes, p = 0.011). Intraoperative complications (0.8% vs. 0%, p > 0.999), conversion to laparotomy (0.8% vs. 0%, p > 0.999), length of hospital stay (3.44 ± 4.27 vs. 3.10 ± 1.67 days, p = 0.337), laboratory parameters, and 30-day morbidity (11% vs. 10%, p = 0.740) were similar between groups. However, recurrence rate (0% vs. 19%, p = 0.008) and the number of patients with reoperation (0% vs 13%, p = 0.048) were lower when using robotics than laparoscopy. Conclusion Robotic-assisted rectopexy demonstrated similar safety outcomes when compared to laparoscopic surgery, with potential advantages in reducing recurrence and reoperation rates.