Robotic Ventral Mesh Rectopexy is a procedure utilising da Vinci® technology, involving mobilisation of the front of the rectum all the way to the pelvic floor, and fixation of the front of the rectum and pelvic floor to the bony sacral promontory with a bio-dissolvable mesh. This straightens the rectum, and restores its tubular shape.
In this technique, the nerves to the rectum that enter from the back and side are preserved with mobilisation only from the front and right side of the rectum. The preservation of nerves at the back of the rectum is thought to improve rectal function and emptying, and reduce the risk of hind gut neuropathy and resultant constipation. The bio-dissolvable mesh is thought to result in a lower recurrence rate than sutured rectopexy whilst avoiding the long-term complications of permanent mesh infection and erosion.
Robotic ventral mesh rectopexy with the da Vinci platform is gaining increasing popularity due to the increased ease with which suturing is able to be performed using the robot within the narrow confines of the bony pelvis. This is largely due to the ability of the articulating miniature robotic endowrist instruments to perform complex fine-motor movements within a confined space.
The other advantage of the Da Vinci robot in this operation is the extra third arm that allows for excellent retraction within the narrow pelvis, and the three-dimensional magnified view allowing visualization of the pre-sacral nerves involved in sexual function, and therefore their preservation.
Main advantage
The main advantage of Robotic Ventral mesh Rectopexy over perineal procedures, is that it is a repair that treats the underlying cause, which is lack of adequate suspension of the rectum. It also avoids any perineal (vaginal or rectal) wound, resulting in less pain and reduced risk of post-operative infection.
