Low anterior resection and rectopexy is the optimal treatment for well functioning patients with rectal prolapse. Reoperations for rectal prolapse may be challenging due to significant adhesions. Use of the robot for low anterior resection and rectopexy is safe, feasible and may be more useful than laparoscopy especially in challenging cases.
Robotic assisted redo rectopexy and low anterior resection.
IMA ligation and sigmoidectomy was performed to eliminate the redundancy in the left colon that contributed to the prolapse. Resection with rectopexy has the lowest recurrence rate for prolapse. Rectopexy done before the anastomosis ensures a more adequate suspension of the posterior pelvic floor. If the anastomoses is done first it covers the sacral promontory making the rectopexy more difficult to do. We have not had tearing of sutures.
Dorsal lithotomy position, preoperative cystoscopy and bilateral ureteral stents, robot docked to the left of the patient
peritoneal reflection, sacral promontory, white line of Toldt
The main advantages of the robotic system for rectal prolapse are improved magnification and picture quality, decreased surgeon fatigue, easier access to the pelvis with articulating instruments and significantly easier suturing. The main disadvantages include increased cost and operative time.