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

Robotic-assisted versus conventional laparoscopic rectopexy for rectal prolapse: a single-center cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Robotic-assisted versus conventional laparoscopic rectopexy for rectal prolapse: a single-center cohort study Nicerine KRAUSE, Joana Rodrigues Ribeiro, Alexandre Balaphas, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6120662/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. rectopexy laparoscopy robotic surgery Figures Figure 1 Figure 2 Introduction The surgical landscape for rectal prolapse repair encompasses a spectrum of techniques, each tailored to the patient’s specific health profile and clinical manifestation( 1 – 3 ). This range includes perineal approaches such as Delorme's mucosectomy and Altemeier's perineal recto-sigmoidectomy, extending to more intricate transabdominal procedures( 3 , 4 ). These latter techniques necessitate comprehensive rectal mobilization, prolapse reduction, and secure rectal fixation. Transabdominal rectopexy, in particular, is characterized by a diversity of technics, including suture rectopexy and various types of mesh implantations, each distinguished by its surgical approach and implementation.( 5 ) The abundance of available techniques for transabdominal rectopexy reflects the absence of conclusive, evidence-based superiority of one method over others, underlining the heterogeneity in patient demographics and clinical presentations( 6 ). Current best practices advocate for minimally invasive approaches in transabdominal rectopexy( 7 , 8 ). Despite their cosmetic advantages and superior outcomes in the postoperative period (shorter length of stay, better pain control), they encounter specific challenges, especially in the context of intra-abdominal suturing. Robotic surgery, on the other hand, could enhance the rectal fixation in difficult cases, whether employing mesh or not, and has been reported to allow similar anatomical correction after MR defecography up to 5 year compared to laparoscopic technic but offers better functional outcomes ( 9 – 13 ). This contrasts with the widespread adoption of robotics, which, despite its advantages in surgeon ergonomics and patients comforts ( 14 ), often entails longer operative times and higher costs, highlighting the importance of carefully weighing its benefits against its limitations ( 15 ). The study aims to compare the outcomes of robotic-assisted versus conventional laparoscopic rectopexy for patients presenting at least rectal prolapse. Methods Ethical board approval Institutional ethical board approval was obtained (project-ID 2024 − 00256). Population A monocentric retrospective observational cohort study was conducted at the University Hospitals Geneva (Geneva, Switzerland). Adult consecutive patients who underwent laparoscopic or robotic rectopexy for rectal prolapse from 2013 to 2023 were considered for inclusion. Patients undergoing open surgery, surgery for rectal prolapse recurrence and/or synchronous procedure, were excluded. Surgical Procedure The most common approach was a minimally invasive mesh rectopexy using a modified unilateral Orr-Loygue procedure, with a resorbable biological mesh in order to avoid erosions ( 16 ). The use of mesh varied on a case-by-case basis, with a wide range of materials employed, including Mersilene (Ethicon, Johnson & Johnson), Mcellise (Betatech Medical), Permacol (Medtronic), Strattice (Bard Davol) and Innovacell (Innovacell Biotechnologies AG). Postoperative care was routinely provided in-hospital, with a standard length of stay ranging from 2 to 5 days, during which pain management and bowel function monitoring were prioritized. Laboratory assessments were typically conducted on postoperative days 2–3 and 5–6, depending on patients’ clinical progress. Patients were discharged upon satisfactory recovery of bowel function, defined as the passage of gas or stool, and overall clinical improvement. Follow-up care included a standardized outpatient consultation at 1 week and 30 days post-surgery, with subsequent follow-ups tailored to the patient’s symptoms and clinical progression. Variables of Interest Data related to patients’ demographics, perioperative outcomes (intraoperative complications, conversion to laparotomy, duration of surgery), short-term perioperative outcomes (laboratory parameters, length of hospital stay, 30-day morbidity, 30-day mortality) ( 17 ), and long-term outcomes (number of reoperations, recurrences) were retrospectively extracted from patients’ charts. Statistical Analyses Descriptive statistics included means, standard deviations, frequencies, and percentages. A bivariate analysis for categorical outcomes, using either the Chi-Square test (χ² test) or Fisher's exact test, was performed depending on the sample size. Specifically, these tests were applied to conversion rates, reoperation rates at 30 days, rehospitalization at 30 days, morbidity at 30 days, and mortality at 30 days. Continuous outcomes were compared either with t-tests or Wilcoxon test, after applying Shapiro-Wilk method to test normality of variable distribution. These analyses were applied to surgical time (skin to skin), length of hospital stay, duration of follow-up, and biomarker levels. For recurrence-free survival analysis, Kaplan-Meier survival curves were used to analyze the time-to-event combined with a log-rank test. Results Inclusion process One hundred and ninety patients underwent rectopexy from January 2013 to December 2023. Of those, 13 patients were excluded as they underwent redo surgery for recurrence, 8 patients were excluded because they underwent open surgery, and 12 patients were excluded for receiving multiple concomitant interventions (hysterectomy, adnexectomy, hernia repair). Ultimately, 157 patients were included in the present analysis. Of those, 130 underwent laparoscopic rectopexy, whereas 27 patients benefited from robotic rectopexy (Fig. 1 ). Study population Baseline characteristics, including age, gender, and ASA score, were comparable between groups (Table 1 ). Intra-operative outcomes Patients in the robotic group were more likely to undergo mesh implantation (96.3% vs. 72.3%, p = 0.006). The mean operative time was significantly longer for robotic procedures when compared to laparoscopic procedures (150 ± 55 minutes vs. 120 ± 51 minutes, p = 0.011). Both conversion to laparotomy and intraoperative complications only occurred once in the laparoscopic group (0.8%,1/130) and did not occur in the robotic group (0%,0/130) (p > 0.999) (Table 1 ). Short-term post-operative outcomes Laboratory values on postoperative day 3 and day 5 showed no statistically significant differences between the laparoscopic and robotic groups. Of note, on postoperative day 3, CRP (80 ± 94 vs. 33 ± 33 mg/L, p > 0.9) and hemoglobin (114 ± 17 vs. 116 ± 3 g/L, p = 0.9) concentrations were comparable between groups (Table 3). Leukocyte counts and creatinine levels demonstrated a trend toward lower values in the robotic group without reaching statistical significance (p = 0.081 and p = 0.067, respectively). By postoperative day 5, no significant differences in CRP, hemoglobin, leukocyte count, or creatinine levels were observed between both groups (all p > 0.3). Laboratory assessments reflected stable recovery profiles across both surgical modalities. The mean length of hospital stay did not significantly differ between the laparoscopic and robotic groups (3.10 ± 1.67 days vs. 3.44 ± 4.27 days, p = 0.337). 30-day morbidity and 30-day mortality were also similar in laparoscopic and robotic approaches (30-day morbidity: 10% vs. 11%, p = 0.740; 30-day mortality: 1.5% vs. 0%, p > 0.999) (Table 1 ). Long-term Outcomes The person-years value was superior in the laparoscopy group (140.8 vs. 18.97 person-years), which also had a longer mean follow-up (426.7 vs. 277.12 days), however not statistical different (p = 0.16) (Table S1). The number of reoperations was significantly different between the two groups (p = 0.048), with a higher rate of reinterventions in the laparoscopic group (11%,14/113), while no reoperations were recorded in the robotic group (Table 1 ). The recurrence rate was significantly higher in the laparoscopic group (p = 0.008), with 25 recurrences noted compared to none in the robotic group. Kaplan-Meier survival analysis was performed to compare recurrence-free survivals, and though log-rank test showed a p-value of 0.078, it should be interpreted cautiously, as there was no event in the robotic group (Fig. 2 ). Discussion This study presents a comparison of robotic-assisted and laparoscopic rectopexy in the management of rectal prolapse, including 157 cases analyzed over a decade in a single institution. Whilst both techniques demonstrated comparable immediate efficacy and safety in addressing rectal prolapse, notable differences were observed in terms of intraoperative practices, surgical outcomes, and long-term follow-up outcomes. Baseline characteristics of the laparoscopic and robotic groups were similar in terms of age, gender, and ASA scores, indicating comparable patient populations despite the study design. However, a significantly higher proportion of patients in the robotic group (96.3 vs. 72.3% in the laparoscopic group, p = 0.006) received mesh, reflecting the evolving guidelines favoring mesh use over time alongside the growing adoption of robotic surgery ( 18 ), as a result of an enhanced dexterity conferred by robot in the confined space of the pelvis facilitating mesh implantation. In terms of safety outcomes, both approaches had similar incidence of intraoperative outcomes. As expected, the robotic approach was associated with a significantly longer operative time. This may be attributed to the learning curve associated with robotic platforms and the additional time required for docking and setup. On the longer term, the robotic group exhibited significantly lower recurrence and reoperation rates when compared to the laparoscopic group. As it may be explained by a potential detection bias due to different lengths of follow-up, we performed Kaplan-Meier analysis, which demonstrated no significant difference in recurrence probability between the groups (p = 0.078). Since the robotic group has zero recurrence event, the interpretation of these results is quite limited, as the log-rank test is not suitable in this context. Still, the robotic cohort’s lower recurrence rates are clinically noteworthy and merit further investigation in larger, prospective studies. The strengths of this study include its focus on a single-institution cohort with homogeneous surgical expertise, ensuring consistency in technique and postoperative care. Furthermore, it provides a comparison of robotic and laparoscopic rectopexy, with a comprehensive evaluation of both short- and long-term outcomes. Several limitations must be acknowledged. The retrospective design introduces the risk for potential selection bias, particularly given the preference for robotic surgery in more complex cases. The relatively small sample size of the robotic group limits the generalizability of findings. Additionally, while Kaplan-Meier survival analysis was used to assess recurrence, the limited number of events necessitates cautious interpretation of these results. Robotic-assisted rectopexy demonstrated optimistic outcomes, particularly in terms of recurrence and reoperation rates, supporting its role in complex cases and patients requiring concomitant pelvic floor repairs. Overall, both robotics and laparoscopy appear at least comparable in terms of safety outcomes. Given the growing application of robotic surgery across various general surgery indications, its satisfactory results in rectal prolapse surgery support its use, particularly as a means to develop surgical expertise with robotic platforms ( 13 , 14 ). Future research should prioritize multi-centric prospective studies to further investigate not only recurrence rates but also functional and patient-related outcomes. Table 1 Comparison of characteristics between two groups laparoscopy N = 130 robot N = 27 p-value Age 65.1(SD = 17.1) 64.8 (SD = 15) Gender 0.300 F 114.0 (87.7%) 26.0 (96.3%) M 16.0 (12.3%) 1.0 (3.7%) ASA 0.110 1 11.0 (8.5%) 1.0 (3.7%) 2 90.0 (69.2%) 24.0 (88.9%) 3 29.0 (22.3%) 2.0 (7.4%) Mesh 0.006 with mesh 94.0 (72.3%) 26.0 (96.3%) without mesh 36.0 (27.7%) 1.0 (3.7%) Intra-operative Complications > 0.999 No complication 129 (99%) 27 (100%) Complication 1 (0.8%) 0 (0%) Conversion to Open > 0.999 No conversion to open surgery 129 (99%) 27 (100%) Conversion to open surgery 1 (0.8%) 0 (0%) Operative Time (minutes) 120 (51) 150 (55) 0.011 Length of stay (days) 3.10 (1.67) 3.44 (4.27) 0.337 Recurrence (1/0) 0.008 0 103 (79%) 26 (96%) 1 25 (19%) 0 (0%) 30 Days Morbidity 0.740 No 117 (90%) 24 (89%) Yes 13 (10%) 3 (11%) 30 Days Mortality > 0.999 No 128 (98%) 27 (100%) Yes 2 (1.5%) 0 Number of Reoperations 0.048 0 113 (87%) 27 (100%) 1 14 (11%) 0 2 3 (2.3%) 0 Declarations Conflict of Interest Statement The authors declare no conflicts of interest related to this study. All results are presented without external influence, and there was no industry involvement in the study design, data collection, analysis, or interpretation. Funding Information None Author Contribution Nicerine Krause and Joana Rodrigues Ribeiro contributed equally to this work and are considered co-first authors. Nicerine Krause designed the study, wrote the main manuscript text, and prepared the figures. Joana Rodrigues Ribeiro collected the data. Alexandre Balaphas assisted in writing the manuscript. Jeremy Meyer supervised the project, contributed to the study design, assisted in writing the main manuscript text, and oversaw the project. All authors reviewed and approved the final manuscript. Acknowledgment We would like to express our gratitude to the clinical staff and research team at the Division of Digestive Surgery for their valuable contributions to this work. Study Declaration This manuscript is submitted as an original article. It represents novel findings and insights into surgical approaches for rectopexy in Switzerland. References Frykman HM. Abdominal proctopexy and primary sigmoid resection for rectal procidentia. Am J Surg. 1955;90(5):780–9. McFerrin C, Pilkington JE, Pilet H, Frilot CF, Gomelsky A. Abdominal versus robotic sacral colpopexy: A detailed analysis of outcomes. Neurourol Urodyn. 2021;40(7):1811–9. Ripstein CB, Lanter B. Etiology and Surgical Therapy of Massive Prolapse of the Rectum: Ann Surg. 1963;157(2):259–64. Wells PC. New Operation for Rectal Prolapse. Tou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev [Internet]. 2015 Nov 24 [cited 2024 Dec 4];2015(11). Available from: http://doi.wiley.com/10.1002/14651858.CD001758.pub3 Kościński T, Szmyt K. What are the surgical options for recurrent rectal prolapse – retrospective single-center experience. Pol J Surg. 2023;96(1):22–6. D’Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20(12):1919–23. Bordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, et al. Clinical Practice Guidelines for the Treatment of Rectal Prolapse. Dis Colon Rectum. 2017;60(11):1121–31. Nosti PA, Andy UU, Kane S, White DE, Harvie HS, Lowenstein L, et al. Outcomes of Abdominal and Minimally Invasive Sacrocolpopexy: A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg. 2014;20(1):33–7. Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S, et al. Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2014;66(2):303–18. Callewaert G, Bosteels J, Housmans S, Verguts J, Van Cleynenbreugel B, Van Der Aa F, et al. Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg. 2016;13(2):115–23. Mäkelä-Kaikkonen J, Rautio T, Pääkkö E, Biancari F, Ohtonen P, Mäkelä J. Robot‐assisted vs laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Dis. 2016;18(10):1010–5. Laitakari KE, Mäkelä-Kaikkonen JK, Pääkkö E, Kata I, Ohtonen P, Mäkelä J, et al. Restored pelvic anatomy is preserved after laparoscopic and robot‐assisted ventral rectopexy: MRI‐based 5‐year follow‐up of a randomized controlled trial. Colorectal Dis. 2020;22(11):1667–76. Evangelopoulos N, Nessi A, Achtari C. Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy. J Robot Surg. 2024;18(1):72. Mudgway R, Tran Z, Quispe Espíritu JC, Bong WB, Schultz H, Vemireddy V, et al. A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy. J Surg Res. 2024;295:47–52. Meyer J, Liot E, Delaune V, Balaphas A, Roche B, Meurette G, et al. Robotic mesh rectopexy for rectal prolapse: The Geneva technique—A video vignette. Colorectal Dis. 2023;25(12):2469–71. Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann Surg. 2009;250(2):187–96. Hajibandeh S, Hajibandeh S, Matthews J, Palmer L, Maw A. Meta-analysis of survival and functional outcomes after total mesorectal excision with or without lateral pelvic lymph node dissection in rectal cancer surgery. Surgery. 2020;168(3):486–96. Additional Declarations No competing interests reported. Supplementary Files Supplementarytables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6120662","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":423852790,"identity":"08589207-f2c3-47e4-baa1-647126632312","order_by":0,"name":"Nicerine KRAUSE","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvklEQVRIiWNgGAWjYDACCQbmxz8MbIAsxsYDxGphM2aoSANpaSBaC4M0w5nDYDZxWsylmx8YF7adt1vbfhhoS41NNEEtlnOOGTye2XY7eduZRKCWY2m5DYS0GNxIMDDgBWoxOwDUwthwmBgt6R8keNvOJZudf0i0lhwDaZ4zB+zMbhBty50zZYYzKpITzG4AbUkgyi+32zc/+GBgZ292Pv3hgw81NoS1wEAiWGUCscpBwJ4UxaNgFIyCUTDCAABDuUt6ezaitgAAAABJRU5ErkJggg==","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":true,"prefix":"","firstName":"Nicerine","middleName":"","lastName":"KRAUSE","suffix":""},{"id":423852792,"identity":"7ecbdaa6-89de-46de-bf3e-7a3ead9fb743","order_by":1,"name":"Joana Rodrigues Ribeiro","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Joana","middleName":"Rodrigues","lastName":"Ribeiro","suffix":""},{"id":423852793,"identity":"741839a3-9e50-4a5e-bb0c-42f9333aaf84","order_by":2,"name":"Alexandre Balaphas","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Alexandre","middleName":"","lastName":"Balaphas","suffix":""},{"id":423852794,"identity":"71f3859d-0e23-43d3-86a7-2d233c29fa28","order_by":3,"name":"Guillaume Meurette","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Guillaume","middleName":"","lastName":"Meurette","suffix":""},{"id":423852795,"identity":"57bae317-544d-4d1f-93f5-28283e094e61","order_by":4,"name":"Frederic Ris","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Frederic","middleName":"","lastName":"Ris","suffix":""},{"id":423852796,"identity":"9bc7e985-bef5-4f04-bcd1-247bab74e8a8","order_by":5,"name":"Emilie Liot","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Emilie","middleName":"","lastName":"Liot","suffix":""},{"id":423852797,"identity":"2a5f7c76-0588-459a-9a37-437dd3539943","order_by":6,"name":"Christian Toso","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Toso","suffix":""},{"id":423852798,"identity":"dc5904d5-2a25-4404-9c7e-70731c18a43f","order_by":7,"name":"Jeremy Meyer","email":"","orcid":"","institution":"University Hospital of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Jeremy","middleName":"","lastName":"Meyer","suffix":""}],"badges":[],"createdAt":"2025-02-27 11:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6120662/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6120662/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78240662,"identity":"fb2c656d-8a8b-4f1e-b36e-097693cd9c71","added_by":"auto","created_at":"2025-03-11 08:58:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":760880,"visible":true,"origin":"","legend":"\u003cp\u003ePatients inclusion flowchart\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6120662/v1/926131c77c964945a29b3481.png"},{"id":78240658,"identity":"42cc5731-0d3e-442b-8dbd-b210e0ad51d3","added_by":"auto","created_at":"2025-03-11 08:58:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46545,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curve between two groups with censored-death\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6120662/v1/11c7aee61e43e366a88f288e.png"},{"id":78833003,"identity":"2200415e-83cf-4bb2-b803-95e4de8cc477","added_by":"auto","created_at":"2025-03-19 14:01:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1458191,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6120662/v1/73fe4b67-838b-4551-8843-bc0401d38603.pdf"},{"id":78240664,"identity":"6066416d-ef7d-47d1-9aaa-c1b6089c90af","added_by":"auto","created_at":"2025-03-11 08:58:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14920,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6120662/v1/e1e20fadcd001c083ebd44f2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Robotic-assisted versus conventional laparoscopic rectopexy for rectal prolapse: a single-center cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe surgical landscape for rectal prolapse repair encompasses a spectrum of techniques, each tailored to the patient\u0026rsquo;s specific health profile and clinical manifestation(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This range includes perineal approaches such as Delorme's mucosectomy and Altemeier's perineal recto-sigmoidectomy, extending to more intricate transabdominal procedures(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These latter techniques necessitate comprehensive rectal mobilization, prolapse reduction, and secure rectal fixation. Transabdominal rectopexy, in particular, is characterized by a diversity of technics, including suture rectopexy and various types of mesh implantations, each distinguished by its surgical approach and implementation.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) The abundance of available techniques for transabdominal rectopexy reflects the absence of conclusive, evidence-based superiority of one method over others, underlining the heterogeneity in patient demographics and clinical presentations(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Current best practices advocate for minimally invasive approaches in transabdominal rectopexy(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Despite their cosmetic advantages and superior outcomes in the postoperative period (shorter length of stay, better pain control), they encounter specific challenges, especially in the context of intra-abdominal suturing. Robotic surgery, on the other hand, could enhance the rectal fixation in difficult cases, whether employing mesh or not, and has been reported to allow similar anatomical correction after MR defecography up to 5 year compared to laparoscopic technic but offers better functional outcomes (\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This contrasts with the widespread adoption of robotics, which, despite its advantages in surgeon ergonomics and patients comforts (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), often entails longer operative times and higher costs, highlighting the importance of carefully weighing its benefits against its limitations (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The study aims to compare the outcomes of robotic-assisted versus conventional laparoscopic rectopexy for patients presenting at least rectal prolapse.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical board approval\u003c/h2\u003e \u003cp\u003e Institutional ethical board approval was obtained (project-ID 2024\u0026thinsp;\u0026minus;\u0026thinsp;00256).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003eA monocentric retrospective observational cohort study was conducted at the University Hospitals Geneva (Geneva, Switzerland). Adult consecutive patients who underwent laparoscopic or robotic rectopexy for rectal prolapse from 2013 to 2023 were considered for inclusion. Patients undergoing open surgery, surgery for rectal prolapse recurrence and/or synchronous procedure, were excluded.\u003c/p\u003e\n\u003ch3\u003eSurgical Procedure\u003c/h3\u003e\n\u003cp\u003eThe most common approach was a minimally invasive mesh rectopexy using a modified unilateral Orr-Loygue procedure, with a resorbable biological mesh in order to avoid erosions (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The use of mesh varied on a case-by-case basis, with a wide range of materials employed, including Mersilene (Ethicon, Johnson \u0026amp; Johnson), Mcellise (Betatech Medical), Permacol (Medtronic), Strattice (Bard Davol) and Innovacell (Innovacell Biotechnologies AG). Postoperative care was routinely provided in-hospital, with a standard length of stay ranging from 2 to 5 days, during which pain management and bowel function monitoring were prioritized. Laboratory assessments were typically conducted on postoperative days 2\u0026ndash;3 and 5\u0026ndash;6, depending on patients\u0026rsquo; clinical progress. Patients were discharged upon satisfactory recovery of bowel function, defined as the passage of gas or stool, and overall clinical improvement. Follow-up care included a standardized outpatient consultation at 1 week and 30 days post-surgery, with subsequent follow-ups tailored to the patient\u0026rsquo;s symptoms and clinical progression.\u003c/p\u003e\n\u003ch3\u003eVariables of Interest\u003c/h3\u003e\n\u003cp\u003eData related to patients\u0026rsquo; demographics, perioperative outcomes (intraoperative complications, conversion to laparotomy, duration of surgery), short-term perioperative outcomes (laboratory parameters, length of hospital stay, 30-day morbidity, 30-day mortality) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and long-term outcomes (number of reoperations, recurrences) were retrospectively extracted from patients\u0026rsquo; charts.\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics included means, standard deviations, frequencies, and percentages. A bivariate analysis for categorical outcomes, using either the Chi-Square test (χ\u0026sup2; test) or Fisher's exact test, was performed depending on the sample size. Specifically, these tests were applied to conversion rates, reoperation rates at 30 days, rehospitalization at 30 days, morbidity at 30 days, and mortality at 30 days. Continuous outcomes were compared either with t-tests or Wilcoxon test, after applying Shapiro-Wilk method to test normality of variable distribution. These analyses were applied to surgical time (skin to skin), length of hospital stay, duration of follow-up, and biomarker levels. For recurrence-free survival analysis, Kaplan-Meier survival curves were used to analyze the time-to-event combined with a log-rank test.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eInclusion process\u003c/h2\u003e \u003cp\u003eOne hundred and ninety patients underwent rectopexy from January 2013 to December 2023. Of those, 13 patients were excluded as they underwent redo surgery for recurrence, 8 patients were excluded because they underwent open surgery, and 12 patients were excluded for receiving multiple concomitant interventions (hysterectomy, adnexectomy, hernia repair). Ultimately, 157 patients were included in the present analysis. Of those, 130 underwent laparoscopic rectopexy, whereas 27 patients benefited from robotic rectopexy (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eBaseline characteristics, including age, gender, and ASA score, were comparable between groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eIntra-operative outcomes\u003c/h2\u003e \u003cp\u003ePatients in the robotic group were more likely to undergo mesh implantation (96.3% vs. 72.3%, p\u0026thinsp;=\u0026thinsp;0.006). The mean operative time was significantly longer for robotic procedures when compared to laparoscopic procedures (150\u0026thinsp;\u0026plusmn;\u0026thinsp;55 minutes vs. 120\u0026thinsp;\u0026plusmn;\u0026thinsp;51 minutes, p\u0026thinsp;=\u0026thinsp;0.011). Both conversion to laparotomy and intraoperative complications only occurred once in the laparoscopic group (0.8%,1/130) and did not occur in the robotic group (0%,0/130) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.999) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eShort-term post-operative outcomes\u003c/h2\u003e \u003cp\u003eLaboratory values on postoperative day 3 and day 5 showed no statistically significant differences between the laparoscopic and robotic groups. Of note, on postoperative day 3, CRP (80\u0026thinsp;\u0026plusmn;\u0026thinsp;94 vs. 33\u0026thinsp;\u0026plusmn;\u0026thinsp;33 mg/L, p\u0026thinsp;\u0026gt;\u0026thinsp;0.9) and hemoglobin (114\u0026thinsp;\u0026plusmn;\u0026thinsp;17 vs. 116\u0026thinsp;\u0026plusmn;\u0026thinsp;3 g/L, p\u0026thinsp;=\u0026thinsp;0.9) concentrations were comparable between groups (Table\u0026nbsp;3). Leukocyte counts and creatinine levels demonstrated a trend toward lower values in the robotic group without reaching statistical significance (p\u0026thinsp;=\u0026thinsp;0.081 and p\u0026thinsp;=\u0026thinsp;0.067, respectively). By postoperative day 5, no significant differences in CRP, hemoglobin, leukocyte count, or creatinine levels were observed between both groups (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.3). Laboratory assessments reflected stable recovery profiles across both surgical modalities. The mean length of hospital stay did not significantly differ between the laparoscopic and robotic groups (3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67 days vs. 3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27 days, p\u0026thinsp;=\u0026thinsp;0.337). 30-day morbidity and 30-day mortality were also similar in laparoscopic and robotic approaches (30-day morbidity: 10% vs. 11%, p\u0026thinsp;=\u0026thinsp;0.740; 30-day mortality: 1.5% vs. 0%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.999) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLong-term Outcomes\u003c/h2\u003e \u003cp\u003eThe person-years value was superior in the laparoscopy group (140.8 vs. 18.97 person-years), which also had a longer mean follow-up (426.7 vs. 277.12 days), however not statistical different (p\u0026thinsp;=\u0026thinsp;0.16) (Table S1). The number of reoperations was significantly different between the two groups (p\u0026thinsp;=\u0026thinsp;0.048), with a higher rate of reinterventions in the laparoscopic group (11%,14/113), while no reoperations were recorded in the robotic group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The recurrence rate was significantly higher in the laparoscopic group (p\u0026thinsp;=\u0026thinsp;0.008), with 25 recurrences noted compared to none in the robotic group. Kaplan-Meier survival analysis was performed to compare recurrence-free survivals, and though log-rank test showed a p-value of 0.078, it should be interpreted cautiously, as there was no event in the robotic group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents a comparison of robotic-assisted and laparoscopic rectopexy in the management of rectal prolapse, including 157 cases analyzed over a decade in a single institution. Whilst both techniques demonstrated comparable immediate efficacy and safety in addressing rectal prolapse, notable differences were observed in terms of intraoperative practices, surgical outcomes, and long-term follow-up outcomes. Baseline characteristics of the laparoscopic and robotic groups were similar in terms of age, gender, and ASA scores, indicating comparable patient populations despite the study design. However, a significantly higher proportion of patients in the robotic group (96.3 vs. 72.3% in the laparoscopic group, p\u0026thinsp;=\u0026thinsp;0.006) received mesh, reflecting the evolving guidelines favoring mesh use over time alongside the growing adoption of robotic surgery (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), as a result of an enhanced dexterity conferred by robot in the confined space of the pelvis facilitating mesh implantation. In terms of safety outcomes, both approaches had similar incidence of intraoperative outcomes. As expected, the robotic approach was associated with a significantly longer operative time. This may be attributed to the learning curve associated with robotic platforms and the additional time required for docking and setup. On the longer term, the robotic group exhibited significantly lower recurrence and reoperation rates when compared to the laparoscopic group. As it may be explained by a potential detection bias due to different lengths of follow-up, we performed Kaplan-Meier analysis, which demonstrated no significant difference in recurrence probability between the groups (p\u0026thinsp;=\u0026thinsp;0.078). Since the robotic group has zero recurrence event, the interpretation of these results is quite limited, as the log-rank test is not suitable in this context. Still, the robotic cohort\u0026rsquo;s lower recurrence rates are clinically noteworthy and merit further investigation in larger, prospective studies.\u003c/p\u003e \u003cp\u003eThe strengths of this study include its focus on a single-institution cohort with homogeneous surgical expertise, ensuring consistency in technique and postoperative care. Furthermore, it provides a comparison of robotic and laparoscopic rectopexy, with a comprehensive evaluation of both short- and long-term outcomes. Several limitations must be acknowledged. The retrospective design introduces the risk for potential selection bias, particularly given the preference for robotic surgery in more complex cases. The relatively small sample size of the robotic group limits the generalizability of findings. Additionally, while Kaplan-Meier survival analysis was used to assess recurrence, the limited number of events necessitates cautious interpretation of these results.\u003c/p\u003e \u003cp\u003eRobotic-assisted rectopexy demonstrated optimistic outcomes, particularly in terms of recurrence and reoperation rates, supporting its role in complex cases and patients requiring concomitant pelvic floor repairs. Overall, both robotics and laparoscopy appear at least comparable in terms of safety outcomes. Given the growing application of robotic surgery across various general surgery indications, its satisfactory results in rectal prolapse surgery support its use, particularly as a means to develop surgical expertise with robotic platforms (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Future research should prioritize multi-centric prospective studies to further investigate not only recurrence rates but also functional and patient-related outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of characteristics between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003elaparoscopy \u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;130\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003erobot \u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;27\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.1(SD\u0026thinsp;=\u0026thinsp;17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.8 (SD\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.0 (87.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.0 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.0 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.0 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.0 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.0 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.0 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMesh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewith mesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94.0 (72.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.0 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ewithout mesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.0 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntra-operative Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConversion to Open\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo conversion to open surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129 (99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConversion to open surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperative Time (minutes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e150 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of stay (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.10 (1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.44 (4.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.337\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence (1/0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30 Days Morbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e30 Days Mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Reoperations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest related to this study. All results are presented without external influence, and there was no industry involvement in the study design, data collection, analysis, or interpretation.\u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNicerine Krause and Joana Rodrigues Ribeiro contributed equally to this work and are considered co-first authors. Nicerine Krause designed the study, wrote the main manuscript text, and prepared the figures. Joana Rodrigues Ribeiro collected the data. Alexandre Balaphas assisted in writing the manuscript. Jeremy Meyer supervised the project, contributed to the study design, assisted in writing the main manuscript text, and oversaw the project. All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e \u003cp\u003eWe would like to express our gratitude to the clinical staff and research team at the Division of Digestive Surgery for their valuable contributions to this work.\u003c/p\u003e \u003ch2\u003eStudy Declaration\u003c/h2\u003e \u003cp\u003eThis manuscript is submitted as an original article. It represents novel findings and insights into surgical approaches for rectopexy in Switzerland.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFrykman HM. Abdominal proctopexy and primary sigmoid resection for rectal procidentia. Am J Surg. 1955;90(5):780\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcFerrin C, Pilkington JE, Pilet H, Frilot CF, Gomelsky A. Abdominal versus robotic sacral colpopexy: A detailed analysis of outcomes. Neurourol Urodyn. 2021;40(7):1811\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRipstein CB, Lanter B. Etiology and Surgical Therapy of Massive Prolapse of the Rectum: Ann Surg. 1963;157(2):259\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWells PC. New Operation for Rectal Prolapse.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTou S, Brown SR, Nelson RL. Surgery for complete (full-thickness) rectal prolapse in adults. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev [Internet]. 2015 Nov 24 [cited 2024 Dec 4];2015(11). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.wiley.com/10.1002/14651858.CD001758.pub3\u003c/span\u003e\u003cspan address=\"http://doi.wiley.com/10.1002/14651858.CD001758.pub3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKościński T, Szmyt K. What are the surgical options for recurrent rectal prolapse \u0026ndash; retrospective single-center experience. Pol J Surg. 2023;96(1):22\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Hoore A, Penninckx F. Laparoscopic ventral recto(colpo)pexy for rectal prolapse: surgical technique and outcome for 109 patients. Surg Endosc. 2006;20(12):1919\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBordeianou L, Paquette I, Johnson E, Holubar SD, Gaertner W, Feingold DL, et al. Clinical Practice Guidelines for the Treatment of Rectal Prolapse. Dis Colon Rectum. 2017;60(11):1121\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNosti PA, Andy UU, Kane S, White DE, Harvie HS, Lowenstein L, et al. Outcomes of Abdominal and Minimally Invasive Sacrocolpopexy: A Retrospective Cohort Study. Female Pelvic Med Reconstr Surg. 2014;20(1):33\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSerati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S, et al. Robot-assisted Sacrocolpopexy for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2014;66(2):303\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallewaert G, Bosteels J, Housmans S, Verguts J, Van Cleynenbreugel B, Van Der Aa F, et al. Laparoscopic versus robotic-assisted sacrocolpopexy for pelvic organ prolapse: a systematic review. Gynecol Surg. 2016;13(2):115\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026auml;kel\u0026auml;-Kaikkonen J, Rautio T, P\u0026auml;\u0026auml;kk\u0026ouml; E, Biancari F, Ohtonen P, M\u0026auml;kel\u0026auml; J. Robot‐assisted \u003cem\u003evs\u003c/em\u003e laparoscopic ventral rectopexy for external or internal rectal prolapse and enterocele: a randomized controlled trial. Colorectal Dis. 2016;18(10):1010\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaitakari KE, M\u0026auml;kel\u0026auml;-Kaikkonen JK, P\u0026auml;\u0026auml;kk\u0026ouml; E, Kata I, Ohtonen P, M\u0026auml;kel\u0026auml; J, et al. Restored pelvic anatomy is preserved after laparoscopic and robot‐assisted ventral rectopexy: MRI‐based 5‐year follow‐up of a randomized controlled trial. Colorectal Dis. 2020;22(11):1667\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvangelopoulos N, Nessi A, Achtari C. Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy. J Robot Surg. 2024;18(1):72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMudgway R, Tran Z, Quispe Esp\u0026iacute;ritu JC, Bong WB, Schultz H, Vemireddy V, et al. A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy. J Surg Res. 2024;295:47\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer J, Liot E, Delaune V, Balaphas A, Roche B, Meurette G, et al. Robotic mesh rectopexy for rectal prolapse: The Geneva technique\u0026mdash;A video vignette. Colorectal Dis. 2023;25(12):2469\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann Surg. 2009;250(2):187\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHajibandeh S, Hajibandeh S, Matthews J, Palmer L, Maw A. Meta-analysis of survival and functional outcomes after total mesorectal excision with or without lateral pelvic lymph node dissection in rectal cancer surgery. Surgery. 2020;168(3):486\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"rectopexy, laparoscopy, robotic, surgery","lastPublishedDoi":"10.21203/rs.3.rs-6120662/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6120662/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMinimally 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOne 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\u0026thinsp;=\u0026thinsp;0.006). Operative times were significantly longer in the robotic group (150\u0026thinsp;\u0026plusmn;\u0026thinsp;55 vs. 120\u0026thinsp;\u0026plusmn;\u0026thinsp;51 minutes, p\u0026thinsp;=\u0026thinsp;0.011). Intraoperative complications (0.8% vs. 0%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.999), conversion to laparotomy (0.8% vs. 0%, p\u0026thinsp;\u0026gt;\u0026thinsp;0.999), length of hospital stay (3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27 vs. 3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67 days, p\u0026thinsp;=\u0026thinsp;0.337), laboratory parameters, and 30-day morbidity (11% vs. 10%, p\u0026thinsp;=\u0026thinsp;0.740) were similar between groups. However, recurrence rate (0% vs. 19%, p\u0026thinsp;=\u0026thinsp;0.008) and the number of patients with reoperation (0% vs 13%, p\u0026thinsp;=\u0026thinsp;0.048) were lower when using robotics than laparoscopy.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRobotic-assisted rectopexy demonstrated similar safety outcomes when compared to laparoscopic surgery, with potential advantages in reducing recurrence and reoperation rates.\u003c/p\u003e","manuscriptTitle":"Robotic-assisted versus conventional laparoscopic rectopexy for rectal prolapse: a single-center cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-11 08:58:25","doi":"10.21203/rs.3.rs-6120662/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1374de18-ffe0-4ae3-a9e6-ebfea9500e48","owner":[],"postedDate":"March 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-19T13:53:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-11 08:58:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6120662","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6120662","identity":"rs-6120662","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}