Robotic Rectal Prolapse Repair

This chapter gives a comprehensive overview of the current standards in the evaluation and surgical management of rectal prolapse, using the Da Vinci surgical system. Rectal prolapse is a disabling condition mostly seen in middle-aged women. The rectal wall protruding in or through the anal canal can lead to symptoms of obstructed defecation and fecal incontinence. A thorough preoperative multi-disciplinary evaluation of patients with rectal prolapse should be performed to look for concomitant prolapse of the middle and anterior pelvic floor compartments. The only definite treatment for rectal prolapse is surgery. This aims at correcting the abnormal anatomy and relieving the associated functional complaints. Numerous procedures have been described including perianal and abdominal approaches and open and minimally invasive techniques. Although there is no international consensus on preferred treatment strategy, currently the two most widely applied surgeries are the ventral rectopexy and the resection rectopexy. Both procedures have been shown safe and feasible performed by either laparoscopy or robot-assisted. Robot-assisted procedures seem to be advantageous in rectal prolapse surgery due to its enhanced maneuverability while performing dissection and suturing deep down the narrow pelvis.