The anatomical effect of robot-assisted ventral mesh rectopexy assessed with upright MRI
Mart Kortman (TNW-M3i); Jan Vanstiphout (ZGT-Chirurgie); Henk-Jan Mantel (ZGT-Chirurgie); Frank Simonis (TNW-MD&I); Anique Grob (TNW-M3i)
Abstract
Introduction:
Robot-assisted ventral mesh rectopexy (RVMR) treats internal rectal prolapse (IRP), anterior rectal bulging (rectocele), and descent of the small intestine (enterocele). RVMR reduces the prolapse in over 90% of the patients, however, in 30-40% of the patients symptoms of fecal incontinence and/or obstructive defecation remain1. Proper investigation is limited by current imaging modalities since X-ray defecography has low soft tissue contrast while magnetic resonance defecography (MRD) suffers from the non-physiological (supine) defecatory position2. We hypothesize that using upright MRD (UMRD) can overcome these limitations.
Objective:
The aim of our study is to analyze the effect of RVMR on pelvic anatomy using UMRD
Method:
15 female patients with IRP were scanned using a 0.25T tilting MR-system (G-scan Brio, Esaote) before and 6 weeks after RVMR. Analysis included distance measurements of the bladder, vaginal vault (VV), anorectal junction (ARJ), and enterocele to the pelvic inclination correction system line3; the M-line and H-line; rectocele size and anorectal angle (ARA) under maximum strain. Significance was assessed using the Wilcoxon signed-rank test, with cut-off adjusted to p<0.006.
Results:
Comparing pre- and postoperative analysis, the VV and enterocele (n=10) were raised by 44 mm and 64 mm respectively, with a significance of p<0.001 and p=0.005. The rectocele size was reduced by 16 mm with a significance of p=0.003. There were no significant alterations in bladder, ARJ, H-line, M-line, and ARA measurements.
Conclusion:
UMRD shows that RVMR significantly reduces VV prolapse, rectocele size, and enterocele. The next step is to determine the correlation with functional outcomes.
Sources:
1. Consten, Esther C.J. MD, PhD; van Iersel, Jan J. MD; Verheijen, Paul M. MD, PhD; Broeders, Ivo A. M. J. MD, PhD; Wolthuis, Albert M. MD; D’Hoore, Andre MD, PhD. Long-term Outcome After Laparoscopic Ventral Mesh Rectopexy: An Observational Study of 919 Consecutive Patients. Annals of Surgery 262(5):p 742-748, November 2015. | DOI: 10.1097/SLA.0000000000001401
2. Fiaschetti, V., Squillaci, E., Pastorelli, D. et al. Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders. Radiol med 116, 620–633 (2011). https://doi.org/10.1007/s11547-011-0660-2
3. Morsinkhof LM, Schulten MK, DeLancey JOL, Simonis FFJ, Grob ATM. Pelvic inclination correction system for magnetic resonance imaging analysis of pelvic organ prolapse in upright position. Int Urogynecol J. 2022 Oct;33(10):2801-2807. doi: 10.1007/s00192-022-05289-0. Epub 2022 Jul 30. PMID: 35907021; PMCID: PMC9477951.