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Purpose <p>Robotic ventral mesh rectopexy (RVMR) has emerged as an effective technique for addressing rectal prolapse (RP) and associated pelvic floor disorders. However, variability persists regarding preoperative evaluation, patient selection, and procedural techniques. This Delphi consensus aims to provide evidence-based recommendations to standardize practice, enhance patient outcomes, and address key gaps in the literature.</p> Methods <p>Thirty-three experts in RVMR participated in a structured Delphi process. The panel addressed 10 key clinical questions, covering preoperative workup, surgical indications, procedural steps, learning curves, training, and RVMR outcomes. The consensus process was reached through iterative surveys, literature reviews, and a rigorous voting methodology, applying the GRADE approach.</p> Results <p>A total of 27 consensus statements were formulated, providing standardized recommendations on patient selection, imaging modalities, surgical technique, and expected clinical outcomes. Concerning surgical technique, the panel addressed variations in trocar placement, robotic instrument selection, and docking strategies. Additionally, consensus statements addressed the role of mesh reinforcement, fixation techniques, and the potential for combined procedures in the treatment of multicompartment pelvic organ prolapse. Of the 27 consensus statements, 3 (11.1%) were supported by moderate-quality evidence, whereas 18 (66.7%) were based on low or very-low-quality evidence and 6 (22.2%) on expert opinion.</p> Conclusion <p>This consensus provides a structured, consensus-based framework for clinicians and surgeons trying to address the complexities of RVMR and promote standardization and quality improvement in RP management, while acknowledging that the underlying evidence remains largely low-quality.</p>

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2025 Delphi consensus on robotic ventral mesh rectopexy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月16日

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  • Carlo Alberto Schena,
  • Simona Ascanelli,
  • Ugo Grossi,
  • Gaetano Gallo,
  • Francesco Marchegiani,
  • Aleix Martínez-Pérez,
  • Gaetano Pavone,
  • Danila Azzolina,
  • Michel Adamina,
  • Paolo Pietro Bianchi,
  • Gabriele Bislenghi,
  • Andrea Braini,
  • Maria Clotilde Carra,
  • Valerio Celentano,
  • Andrea Coratti,
  • Francesca Da Pozzo,
  • Paola De Nardi,
  • Veronica De Simone,
  • André D’Hoore,
  • Eloy Espin-Basany,
  • Alfredo Genovese,
  • Jim Khan,
  • Leonardo Lenisa,
  • Jacopo Martellucci,
  • Ruby Martinello,
  • Michele Masetti,
  • Marco Milone,
  • Gabriele Naldini,
  • Gianluca Pellino,
  • Pierpaolo Sileri,
  • Angelo Stuto,
  • Pasquale Talento,
  • Mario Testini,
  • Alfredo Tonsi,
  • Carlo Ratto,
  • Nicola de’Angelis,
  • Isabella Dall’Oco Tundo,
  • Marta Goglia,
  • Giorgio La Greca,
  • Aurora Marotta,
  • Angelo Alessandro Marra,
  • Valentina Sani

摘要

Purpose

Robotic ventral mesh rectopexy (RVMR) has emerged as an effective technique for addressing rectal prolapse (RP) and associated pelvic floor disorders. However, variability persists regarding preoperative evaluation, patient selection, and procedural techniques. This Delphi consensus aims to provide evidence-based recommendations to standardize practice, enhance patient outcomes, and address key gaps in the literature.

Methods

Thirty-three experts in RVMR participated in a structured Delphi process. The panel addressed 10 key clinical questions, covering preoperative workup, surgical indications, procedural steps, learning curves, training, and RVMR outcomes. The consensus process was reached through iterative surveys, literature reviews, and a rigorous voting methodology, applying the GRADE approach.

Results

A total of 27 consensus statements were formulated, providing standardized recommendations on patient selection, imaging modalities, surgical technique, and expected clinical outcomes. Concerning surgical technique, the panel addressed variations in trocar placement, robotic instrument selection, and docking strategies. Additionally, consensus statements addressed the role of mesh reinforcement, fixation techniques, and the potential for combined procedures in the treatment of multicompartment pelvic organ prolapse. Of the 27 consensus statements, 3 (11.1%) were supported by moderate-quality evidence, whereas 18 (66.7%) were based on low or very-low-quality evidence and 6 (22.2%) on expert opinion.

Conclusion

This consensus provides a structured, consensus-based framework for clinicians and surgeons trying to address the complexities of RVMR and promote standardization and quality improvement in RP management, while acknowledging that the underlying evidence remains largely low-quality.