Scoping review of indications for robotic ventral mesh rectopexy: addressing variability in patient selection

Introduction: Ventral mesh rectopexy (VMR) has gained popularity as a surgical solution for rectal prolapse. However, significant variability exists in patient selection criteria, preoperative evaluation, and reporting standards. This scoping review analyzes indications for robotic VMR (RVMR) and highlights areas requiring further standardization. Methods: The review was conducted according to PRISMA-ScR guidelines. Comprehensive searches of PubMed, Scopus, and Web of Science were completed through December 4, 2024. Studies reporting on RVMR were screened in a three-step process, with disagreements resolved by consensus. Key data extracted included patient demographics, indications, preoperative workup, and surgical details. Superseded studies, reviews, and non-relevant articles were excluded. Results: Of 783 articles identified, 24 studies comprising 930 patients met inclusion criteria. External rectal prolapse was the most common indication (47%), followed by intussusception (38%), rectocele (9%), combined abnormalities (5%), and enterocele (1%). Preoperative imaging was inconsistently reported, with only 67% of studies describing imaging protocols. Symptom-based indications using standardized scoring systems were rare (17%). Synthetic mesh was used in 87% of cases. RVMR showed favorable functional outcomes, with low recurrence and complication rates. Conclusions: Significant heterogeneity exists in indications and preoperative evaluation for RVMR, limiting comparability across studies. While evidence supports its safety and efficacy, future research should focus on standardizing selection criteria and evaluating long-term outcomes.