Robot-assisted pelvic floor reconstructive surgery: an international Delphi study of expert users.
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Simoncini Tommaso, Panattoni Andrea, Aktas Mustafa, Ampe Jozef, Betschart Cornelia, Bloemendaal Alexander L A, Buse Stephan, Campagna Giuseppe, Caretto Marta, Cervigni Mauro, Consten Esther C J, Davila Hugo H, Dubuisson Jean, Espin-Basany Eloy, Fabiani Bernardina, Faucheron Jean-Luc, Giannini Andrea, Gurland Brooke, Hahnloser Dieter, Joukhadar Ralf, Mannella Paolo, Mereu Liliana, Martellucci Jacopo, Meurette Guillaume, Montt Guevara Maria Magdalena, Ratto Carlo, O'Reilly Barry A, Reisenauer Christl, Russo Eleonora, Schraffordt Koops Steven, Siddiqi Shahab, Sturiale Alessandro, Naldini Gabriele
Аннотация
METHODS: We set up an international, multidisciplinary group of 26 experts to participate in a Delphi process on robotics as applied to pelvic floor reconstructive surgery. The group comprised urogynecologists, urologists, and colorectal surgeons with long-term experience in the performance of pelvic floor reconstructive procedures and with the use of the robot, who were identified primarily based on peer-reviewed publications. Two rounds of the Delphi process were conducted. The first included 63 statements pertaining to surgeons' characteristics, general questions, indications, surgical technique, and future-oriented questions. A second round including 20 statements was used to reassess those statements where borderline agreement was obtained during the first round. The final step consisted of a face-to-face meeting with all participants to present and discuss the results of the analysis.
RESULTS: The 26 experts agreed that robotics is a suitable indication for pelvic floor reconstructive surgery because of the significant technical advantages that it confers relative to standard laparoscopy. Experts considered these advantages particularly important for the execution of complex reconstructive procedures, although the benefits can be found also during less challenging cases. The experts considered the robot safe and effective for pelvic floor reconstruction and generally thought that the additional costs are offset by the increased surgical efficacy.
CONCLUSION: Robotics is a suitable choice for pelvic reconstruction, but this Delphi initiative calls for more research to objectively assess the specific settings where robotic surgery would provide the most benefit.