2025 Delphi consensus on robotic ventral mesh rectopexy

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.