Thesis defence in the University of Oulu

Doctoral Candidate

Licentiate of Medicine Johanna Mäkelä-Kaikkonen

Faculty and research unit

University of Oulu Graduate School, Faculty of Medicine, Medical Research Center Oulu

Field of study

Medicine

Date and time of the thesis defence

29.3.2019 12:00

Place of the thesis defence

Oulu University Hospital, auditorium 1 and 2

Topic of the dissertation

Robotic-assisted and laparoscopic ventral rectopexy in the treatment of posterior pelvic floor procidentia.

Opponent

Docent Tom Scheinin, University of Helsinki, Helsinki University Hospital

Custos

Professor Jyrki Mäkelä, University of Oulu

Robotic-assisted and laparoscopic rectopexy in the treatment of posterior pelvic floor procidentia

Robotic-assisted and laparoscopic ventral rectopexy restore pelvic organ prolapses and improve pelvic floor function Symptomatic pelvic organ prolapses are common in female population and present as urinary and defecatory dysfunction, feeling of bulge and pelvic pain. The main risk factor to develop pelvic organ prolapses is vaginal delivery.

In the thesis, pelvic organ prolapses and their operative correction were assessed with clinical examination and dynamic magnetic resonance imaging (MRI). The results demonstrate that ventral rectopexy operation restores effectively the anatomy of the posterior and middle pelvic floor compartments and reduces the mobility of pelvic organs in patients with external rectal prolapse and with its less severe form, symptomatic internal rectal prolapse.

The results of the follow-up study showed, that symptoms of obstructed defecation, fecal incontinence and bulge feeling are significantly relived after robotic-assisted and laparoscopic rectopexy operations. Sexual function and quality of life associated with bowel and gynecological prolapse symptoms were also improved. The general health-related quality of life of the studied patient population was however reduced in wide dimensions when compared to age-standardized Finnish population.

Robotic-assisted surgery with its advanced features may offer better conditions for the surgeon when operating in narrow pelvic space. This has been thought to possibly turn into better operative results for the patient. The conventional laparoscopic technique and newer robotic-assisted rectopexy techniques were compared in the study an found to be equal in most relevant outcome measures, such operating time, complications and anatomic and functional results. As the study found no clear patient benefits of the robotic surgery, the added cost of the routine use of robots for these operations are not currently justified.

In a large multicenter study of four Finnish hospitals the operation was shown to have an impact to whole pelvic floor function and the improvement in symptoms were observed to be retained in the long-term. The risk of recurrence was low and the occurrence of complicatios was at acceptable level. The primary prolapse type affected significantly to the end-result. Eighty-six percent of patients operated for external rectal prolapse were satisfied with the symptom-relief whereas of those operated for symptomatic internal rectal prolapse 6-7 of ten patients benefit of the operation.

The results of the thesis can be used for guidance in treatment planning and for patient information.

 

Dissertation

Last updated: 5.4.2019