EP810 - Technical Variations During Robotic Ventral Rectopexy

Monday, May 12, 2025

1:47 PM – 1:52 PM PT

Senior Author(s)

Brooke Gurland, MD, FASCRS, FACS

Clinical Professor of Surgery
Stanford University
Stanford Surgery
MENLO PARK, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

ePoster Presenter(s)

Shreya Rana

Clinical Research Intern
Stanford University
San Ramon, CA, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

Sydni Au Hoy, n/a (she/her/hers)

Clinical Research Coordinator
Stanford University
Stanford University
Palo Alto, California, United States

Disclosure information not submitted.
Angelo A. Marra, MD, PhD (he/him/his)

General Surgeon
Isola Tiberina - Gemelli Isola Hospital
Rome, Lazio, Italy

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MA

Mohamed Abasbassi, MD

Surgeon
AZ Oostende
Oostende, West-Vlaanderen, Belgium

Disclosure information not submitted.
Td

Teresa deBeche-Adams, MD

Colorectal Surgeon, Division Chair
AdventHealth
Orlando, Florida, United States

Disclosure information not submitted.
AM

Amanda McClure

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
James Ogilvie, Jr., MD

Attending Physician
Corewell Health
MIchigan State University
Grand Rapids, Michigan, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Craig H. Olson, MD

Colorectal Surgeon
Baylor Scott and White Waxahachie
Texas A&M Medical School
Waxahachie, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
William R. Perry, M.B. Ch.B. M.P.H (he/him/his)

Colorectal Surgeon
Mayo Clinic
Mayo Clinic
Rochester, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Carlo Ratto, MD, Hon Int F.A.S.C.R.S.

M.D., Hon Int F.A.S.C.R.S.
Isola Tiberina - Gemelli Isola Hospital
Catholic University, Rome, Italy
Rome, Lazio, Italy

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AS

Andrew Stevenson, MD

Clinical Professor of Surgery
University of Queensland
Brisbane, Queensland, Australia

Disclosure information not submitted.
Amy J. Thorsen, MD (she/her/hers)

Associate Professor of Surgery
University of Minnesota
Hopkins, Minnesota, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Brooke Gurland, MD, FASCRS, FACS: This individual has no financial relationships with ineligible companies.

Shreya Rana: This individual has no financial relationships with ineligible companies.

Angelo A. Marra, MD, PhD: This individual has no financial relationships with ineligible companies.

Amanda McClure: This individual has no relevant relationships with ineligible companies.

James Ogilvie, MD, Jr.: This individual has no relevant relationships with ineligible companies.

Craig H. Olson, MD: This individual has no relevant relationships with ineligible companies.

William R. Perry, M.B. Ch.B. M.P.H: This individual has no financial relationships with ineligible companies.

Carlo Ratto, M.D., Hon Int F.A.S.C.R.S.: This individual has no financial relationships with ineligible companies.

Amy J. Thorsen, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

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 (Figure 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.