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Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea. Medicina (B Aires) 2023; 59:medicina59030582. [PMID: 36984583 PMCID: PMC10059805 DOI: 10.3390/medicina59030582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.
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Laparoscopic versus robotic inguinal hernia repair: 1- and 2-year outcomes from the RIVAL trial. Surg Endosc 2023; 37:723-728. [PMID: 35578051 DOI: 10.1007/s00464-022-09320-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/27/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Robotic inguinal hernia repair is growing in popularity among general surgeons despite little high-quality evidence supporting short- or long-term advantages over traditional laparoscopic inguinal hernia repair. The original RIVAL trial showed increased operative time, cost, and surgeon frustration for the robotic approach without advantages over laparoscopy. Here we report the 1- and 2-year outcomes of the trial. METHODS This is a multi-center, patient-blinded, randomized clinical study conducted at six sites from 2016 to 2019, comparing laparoscopic versus robotic transabdominal preperitoneal (TAPP) inguinal hernia repair with follow-up at 1 and 2 years. Outcomes include pain (visual analog scale), neuropathic pain (Leeds assessment of neuropathic symptoms and signs pain scale), wound morbidity, composite hernia recurrence (patient-reported and clinical exam), health-related quality of life (36-item short-form health survey), and physical activity (physical activity assessment tool). RESULTS Early trial participation included 102 patients; 83 (81%) completed 1-year follow-up (45 laparoscopic vs. 38 robotic) and 77 (75%) completed 2-year follow-up (43 laparoscopic vs. 34 robotic). At 1 and 2 years, pain was similar for both groups. No patients in either treatment arm experienced neuropathic pain. Health-related quality of life and physical activity were similar for both groups at 1 and 2 years. No long-term wound morbidity was seen for either repair type. At 2 years, there was no difference in hernia recurrence (1 laparoscopic vs. 1 robotic; P = 1.0). CONCLUSIONS Laparoscopic and robotic inguinal hernia repairs have similar long-term outcomes when performed by surgeons with experience in minimally invasive inguinal hernia repairs.
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Ayuso SA, Marturano MN, Katzen MM, Aladegbami BG, Augenstein VA. Laparoscopic versus robotic inguinal hernia repair: a single-center case-matched study. Surg Endosc 2023; 37:631-637. [PMID: 35902404 DOI: 10.1007/s00464-022-09368-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 05/23/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Robotic inguinal hernia repair (RIHR) is becoming increasingly common and is the minimally invasive alternative to laparoscopic inguinal hernia repair (LIHR). Thus far, there is little data directly comparing LIHR and RIHR. The purpose of this study will be to compare outcomes for LIHR and RIHR at a single center. METHODS A prospective institutional hernia database was queried for patients who underwent transabdominal LIHR or RIHR from 2012 to 2020. The patients were then matched based on the surgeon performing the operation (single, expert hernia surgeon) and laterality of repair. Standard descriptive statistics were used. RESULTS There were 282 patients who met criteria for the study, 141 LIHR and 141 RIHR; 32.6% of patients in each group had a bilateral repair (p = 1.00). LIHR patients were slightly younger (54.4 ± 15.6 vs 58.6 ± 13.8; p = 0.03) but similar in terms of BMI (27.1 ± 5.1 vs 29.1 ± 2.1; p = 0.70) and number of comorbidities (2.9 ± 2.5 vs 2.6 ± 2.2; p = 0.59). Operative time was found to be longer in the RIHR group, but when evaluating RIHR at the beginning of the study versus the end of the study, there was a 50-min decrease in operative time (p < 0.01). Recurrence rates were low for both groups (0.7% vs 1.4%; p = 0.38) with mean follow-up time 13.0 ± 13.3 months. There was only one wound infection, which was in the robotic group. No patients required return to the operating room for complications relating to their surgery. There were no 30-day readmissions in the LIHR group and three 30-day readmissions in the RIHR group (p = 0.28). CONCLUSION LIHR and RIHR are both performed with low morbidity and have comparable overall outcomes. The total charges were increased in the RIHR group. Either LIHR or RIHR may be considered when performing inguinal hernia repair and should depend on surgeon and patient preference; continued evaluation of the outcomes is warranted.
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Affiliation(s)
- Sullivan A Ayuso
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Matthew N Marturano
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Michael M Katzen
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Bola G Aladegbami
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA
| | - Vedra A Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
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Vitiello A, Abu Abeid A, Peltrini R, Ferraro L, Formisano G, Bianchi PP, Del Giudice R, Taglietti L, Celentano V, Berardi G, Bracale U, Musella M. Minimally Invasive Repair of Recurrent Inguinal Hernia: Multi-Institutional Retrospective Comparison of Robotic Versus Laparoscopic Surgery. J Laparoendosc Adv Surg Tech A 2023; 33:69-73. [PMID: 35877826 DOI: 10.1089/lap.2022.0209] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Inguinal hernia repair is one of the most commonly performed surgical procedures in general surgery. Despite surgical advances, recurrence and chronic pain are still major issues after this intervention. Aim of our study was to retrospectively assess and compare outcomes of robotic versus laparoscopic repair of recurrent inguinal hernia. Methods: All patients who underwent recurrent inguinal hernia repair between 2014 and 2021 in five different institutions were included in our study. Baseline data on age, gender, body mass index, comorbidities, smoking habit, and anticoagulant therapy were retrospectively collected from prospectively maintained databases. Operative time, length of stay, and early and late complications were compared between the robotic and the laparoscopic approach. Results: Forty-eight patients underwent recurrent inguinal hernia repair between January 2014 and December 2021. Twenty-three patients underwent a robotic procedure, whereas 25 were submitted to the laparoscopic intervention. Overall mean follow-up was 26.2 months. There was no significant difference in the baseline characteristics of the two groups. Acceptable and comparable rates of peri- and postoperative outcomes were recorded. However, postoperative visual analog scale score and incidence of chronic pain were lower after the robotic rather than after the laparoscopic approach. (2.9 versus 3.8 P = .002; 20% versus 0%; P = .02, respectively). Conclusions: Minimally invasive repair of recurrent inguinal hernia is safe and feasible; robotic surgery is associated with low rate of postoperative and chronic pain without a significant increase in operative time.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Napoli, Italy
| | - Adam Abu Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roberto Peltrini
- Public Health Department, Naples "Federico II" University, Napoli, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, Milano, Italy
| | - Giampaolo Formisano
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, Milano, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, Milano, Italy
| | | | | | - Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust. London, United Kingdom
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Napoli, Italy
| | - Umberto Bracale
- Public Health Department, Naples "Federico II" University, Napoli, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Napoli, Italy
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Implementation of robotic hernia surgery using the Versius® system. J Robot Surg 2022; 17:565-569. [PMID: 35951280 PMCID: PMC9366786 DOI: 10.1007/s11701-022-01451-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2022] [Indexed: 10/24/2022]
Abstract
This case series aims to demonstrate that hernia surgery is safe and feasible using the Versius® robotic system from CMR Surgical, and to describe the surgical techniques used. It is the first series published using this novel system. Forty-one consecutive hernia repair cases were completed using Versius®, including inguinal and ventral hernias. Data were collected prospectively on a number of pre-, peri-, and postoperative outcomes. Techniques are described for robotic transabdominal preperitoneal repair of inguinal hernia, and intraperitoneal onlay mesh repair of ventral hernia. Thirty-two inguinal and nine ventral hernia repairs were performed over a 12-month period. The population were 88% male with a mean body mass index of 27.4 ± 3.5. There were no conversions to open surgery. Median length of stay was 0 days. Six patients (15%) experienced urinary retention, and there were 2 further minor complications with no major complications, readmissions or reoperations. Use of the Versius® system for robotic hernia surgery is safe, with comparable results to existing robotic systems. Implementation is possible with minimal changes to established surgical techniques.
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Amaral PHDEF, Pivetta LGA, Dias ERM, Carvalho JPVDE, Furtado M, Malheiros CA, Roll S. Robotic re-TAPP: a minimally invasive alternative for the failed posterior repair. Rev Col Bras Cir 2022; 49:e20223063. [PMID: 35239851 PMCID: PMC10578846 DOI: 10.1590/0100-6991e-20223063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. METHODS patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. RESULTS nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. CONCLUSIONS on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
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Affiliation(s)
- Pedro Henrique DE Freitas Amaral
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | | | - Eduardo Rullo Maranhão Dias
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - João Paulo Venancio DE Carvalho
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Marcelo Furtado
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
| | - Carlos Alberto Malheiros
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
| | - Sergio Roll
- - Hospital Alemão Oswaldo Cruz, Centro de Hérnia - São Paulo - SP - Brasil
- - Santa Casa de São Paulo, Grupo de Parede Abdominal e Cirurgia Bariátrica - Departamento de Cirurgia - São Paulo - SP - Brasil
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Prabhu AS, Carbonell A, Hope W, Warren J, Higgins R, Jacob B, Blatnik J, Haskins I, Alkhatib H, Tastaldi L, Fafaj A, Tu C, Rosen MJ. Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair: The RIVAL Randomized Clinical Trial. JAMA Surg 2021; 155:380-387. [PMID: 32186683 DOI: 10.1001/jamasurg.2020.0034] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Despite rapid adoption of the robotic platform for inguinal hernia repair in the US, to date, no level I trials have ever compared robotic inguinal hernia repair to laparoscopic repair. This multicenter randomized clinical trial is the first to compare the robotic platform to laparoscopic approach for minimally invasive inguinal hernia repair. Objective To determine whether the robotic approach to inguinal hernia repair results in improved postoperative outcomes compared with traditional laparoscopic inguinal hernia repairs. Design, Setting, and Participants This multicenter, single-blinded, prospective randomized clinical pilot study was conducted from April 2016 to April 2019, with a follow-up duration of 30 days in 6 academic and academic-affiliated sites. Enrolled in this study were 113 patients with a unilateral primary or recurrent inguinal hernia. After exclusions 102 remained for analysis. Interventions Standard laparoscopic transabdominal preperitoneal repair or robotic transabdominal preperitoneal repair. Main Outcomes and Measures Main outcomes included postoperative pain, health-related quality of life, mobility, wound morbidity, and cosmesis. Secondary outcomes included cost, surgeon ergonomics, and surgeon mental workload. A primary outcome was not selected because this study was designed as a pilot study. The hypothesis was formulated prior to data collection. Results A total of 102 patients were included in the study (54 in the laparoscopic group, mean [SD] age, 57.2 [13.3] years and 48 [88.9%] male; 48 in the robotic group, mean [SD] age, 56.1 [14.1] years and 44 [91.6%] male). There were no differences at the preoperative, 1-week, or 30-day points between the groups in terms of wound events, readmissions, pain as measured by the Visual Analog Scale, or quality of life as measured by the 36-Item Short Form Health Survey. Compared with traditional laparoscopic inguinal hernia repair, robotic transabdominal preperitoneal repair was associated with longer median (interquartile range) operative times (75.5 [59.0-93.8] minutes vs 40.5 [29.2-63.8] minutes, respectively; P < .001), higher median (interquartile range) cost ($3258 [$2568-$4118] vs $1421 [$1196-$1930], respectively; P < .001), and higher mean (SD) frustration levels on the NASA Task Load Index Scale (range, 1-100, with lower scores indicating lower cognitive workload) (32.7 [23.5] vs 20.1 [19.2], respectively; P = .004). There were no differences in ergonomics of the surgeons between the groups as measured by the Rapid Upper Limb Assessment instrument. Conclusions and Relevance Results of this study showed no clinical benefit to the robotic approach to straightforward inguinal hernia repair compared with the laparoscopic approach. The robotic approach incurred higher costs and more operative time compared with the laparoscopic approach, with added surgeon frustration and no ergonomic benefit to surgeons. Trial Registration ClinicalTrials.gov Identifier: NCT02816658.
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Affiliation(s)
- Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alfredo Carbonell
- Comprehensive Hernia Center, Department of Surgery, University of South Carolina School of Medicine Greenville, Greenville
| | - William Hope
- Department of Surgery, New Hanover Regional Medical Center, University of North Carolina Wilmington, Wilmington
| | - Jeremy Warren
- Comprehensive Hernia Center, Department of Surgery, University of South Carolina School of Medicine Greenville, Greenville
| | - Rana Higgins
- Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Brian Jacob
- Department of Surgery, Mount Sinai Hospital, New York, New York
| | - Jeffrey Blatnik
- Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Ivy Haskins
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - Hemasat Alkhatib
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Luciano Tastaldi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Surgery, University of Texas Medical Branch, Galveston
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chao Tu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Diseases and Surgery Institute, Cleveland Clinic, The Cleveland Clinic Foundation, Cleveland, Ohio
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Morrell ALG, Morrell Junior AC, Mendes JMF, Morrell AG, Morrell A. Robotic TAPP inguinal hernia repair: lessons learned from 97 cases. Rev Col Bras Cir 2021; 48:e20202704. [PMID: 33533825 PMCID: PMC10683431 DOI: 10.1590/0100-6991e-20202704] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES minimally invasive inguinal hernia repair has proven advantages over open procedures including less pain and earlier return to normal activity. Robotic surgery adds ergonomics, a three-dimensional high definition camera and articulating instruments overcoming some laparoscopic limitations. We aimed to report the outcomes of the early experience of over 97 robotic inguinal hernia repairs performed by a referred surgical group in Brazil. METHODS a review of a prospective mantined database was conducted in patients submitted to robotic transabdominal preperitoneal (TAPP) inguinal hernia repairs between March 2016 and February 2020. Descriptive statistics were performed. Surgical outcomes data and patient follow-ups are reported. RESULTS retrospective chart review identified 97 patients submitted to robotic TAPP inguinal hernia repair. Mean age was 36.4 years, with median BMI of 26.9 kg/m2. Mean console time was 58 min (range 40-150) and patients were discharged within 24 hours of their stay in a majority of cases. Mesh was placed in all procedures and there were no conversion rates. Complications were low grade and no recurrence was seen after a mean follow-up of 642 days. CONCLUSION this study represents to-date the first brazilian case series of robotic TAPP inguinal hernia repair. Our results encourage that robotic assisted TAPP inguinal hernia repair appears to be technically feasible and safe in experienced hands, with good outcomes achieving high health-related quality of life and low recurrence rates in the short and long term.
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Affiliation(s)
- Andre Luiz Gioia Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Alexander Charles Morrell Junior
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Jose Mauricio Freitas Mendes
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
| | - Allan Gioia Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
| | - Alexander Morrell
- - Instituto Morrell, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein, Cirurgia Geral e Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Vila Nova Star - Rede D'Or Hospital São Luiz, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
- - Hospital Alemão Oswaldo Cruz, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia Robótica e Minimamente Invasiva do Aparelho Digestivo - São Paulo - SP - Brasil
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Kakiashvili E, Bez M, Abu Shakra I, Ganam S, Bickel A, Merei F, Drobot A, Bogouslavski G, Kassis W, Khatib K, Badran M, Kluger Y, Almog R. Robotic inguinal hernia repair: Is it a new era in the management of inguinal hernia? Asian J Surg 2021; 44:93-98. [DOI: 10.1016/j.asjsur.2020.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 02/02/2023] Open
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10
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Gundogdu E, Guldogan CE, Ozmen MM. Bilateral Inguinal Hernia Repair: Robotic TAPP Versus Laparoscopic TEP. Surg Laparosc Endosc Percutan Tech 2020; 31:439-443. [PMID: 33347086 DOI: 10.1097/sle.0000000000000890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND As the advantages of minimally invasive techniques in general surgery have been shown, we prefer laparoscopic total extraperitoneal (LTEP) inguinal hernia repair or robotic transabdominal preperitoneal (RTAPP) inguinal hernia repair in patients diagnosed especially with a bilateral inguinal hernia in our practice. The present study aims to evaluate the early/midterm outcomes and complications in patients who underwent LTEP and RTAPP because of bilateral inguinal hernia. MATERIALS AND METHODS In total, 189 patients underwent inguinal hernia repair between June 2016 and June 2019 in our department. Data of 49 (2F) patients (33 LTEP/16 RTAPP) who had undergone bilateral inguinal hernia repair were evaluated retrospectively. Univariate analysis was performed to identify the relations between the techniques (LTEP vs. RTAPP), outcomes, and complications. RESULTS Patient demographics and comorbidities were similar in both groups. There was no difference between the groups in terms of American Society of Anesthesiologists (ASA) scores (P=0.09). Operative time was longer in the RTAPP group (P=0.001). Length of hospital stay was similar in both groups (P=0.11). No recurrence was observed in both groups. Mean pain scores were significantly less for the RTAPP group (P=0.05). When general complications were compared, it was found that the RTAPP group had a statistically significant lower complication rate (P=0.02). Mean follow-up was longer in the LTEP group (P=0.04). Total hospital costs for RTAPP and LTEP were 3968$ and 2506$, respectively. CONCLUSIONS We conclude that RTAPP seems to have better results in terms of general complications and postoperative pain score when compared with LTAPP. Robotic surgery might be safely recommended for bilateral inguinal hernia repair.
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Affiliation(s)
| | | | - Mehmet Mahir Ozmen
- Department of Surgery, Liv Hospital, Ankara
- Department of Surgery, Medical School, Istinye University, Istanbul, Turkey
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11
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Janjua H, Cousin-Peterson E, Barry TM, Kuo MC, Baker MS, Kuo PC. Robotic Approach to Outpatient Inguinal Hernia Repair. J Am Coll Surg 2020; 231:61-72. [PMID: 32380165 DOI: 10.1016/j.jamcollsurg.2020.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robotics offers improved ergonomics, visualization, instrument articulation, and tremor filtration. Disadvantages include startup cost and system breakdown. Surgeon education notwithstanding, we hypothesize that robotic inguinal hernia repair carries minimal advantages over the laparoscopic or open approach. METHODS The 2009-2015 Healthcare Cost and Utilization Project-State Ambulatory Surgery and Services and American Hospital Association Annual Health data sets from Florida were queried for open, laparoscopic, and robotic inguinal hernia repairs. Hospital and patient demographic, financial, and comorbidity data (26 total variables) were evaluated. Data are presented as mean ± SEM; p < 0.05 was considered significant. RESULTS We identified 103,183 cases (63,375 open, 38,886 laparoscopic, and 922 robotic). Patient characteristics were the following: male, white, aged 51 to 70 years, nongovernmental and not-for-profit hospitals, grouped Charlson Comorbidity Category = 0, private insurance coverage, median income quartile 3 (4 = highest), and routine discharge disposition (all, p < 0.05). Total charges were: $18,261 ± $38 (open), $25,223 ± $60 (laparoscopic), and $45,830 ± $1,023 (robot) (p < 0.0001 robot vs open, robot vs laparoscopic, and laparoscopic vs open). Top factors associated with open procedures (area under the curve 0.785): hospital is investor owned for profit, self-pay, black, Latino, and Medicaid; with laparoscopic procedures (area under the curve 0.771): private insurance, median income quartile 4 (highest), median income quartile 3, median income quartile 2, and nongovernmental, not-for-profit hospitals; and with robotic procedures (area under the curve 0.936): Charlson Comorbidity Category = 2, Charlson Comorbidity Category = 1, median income quartile 3, median income quartile 2, and age. CONCLUSIONS Robotic surgery has increased charges and is performed in sicker, higher-income patients. The open approach is more apt to be performed in black/Hispanic, self-pay patients, and for-profit hospitals. The role for robotic inguinal hernia repair is undefined.
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Affiliation(s)
- Haroon Janjua
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Evelena Cousin-Peterson
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Tara M Barry
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Marissa C Kuo
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL; OnetoMap Analytics, University of South Florida, Tampa, FL.
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Aghayeva A, Benlice C, Bilgin IA, Bengur FB, Bas M, Kirbiyik E, Aytac E, Baca B. Laparoscopic totally extraperitoneal vs robotic transabdominal preperitoneal inguinal hernia repair: Assessment of short‐ and long‐term outcomes. Int J Med Robot 2020; 16:e2111. [DOI: 10.1002/rcs.2111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Afag Aghayeva
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Cigdem Benlice
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Ismail A. Bilgin
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Fuat B. Bengur
- Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Mustafa Bas
- Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Ebru Kirbiyik
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Erman Aytac
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
| | - Bilgi Baca
- Department of General SurgeryAcibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
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13
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Richmond BK, Totten C, Roth JS, Tsai J, Madabhushi V. Current strategies for the management of inguinal hernia: What are the available approaches and the key considerations? Curr Probl Surg 2019; 56:100645. [PMID: 31581983 DOI: 10.1016/j.cpsurg.2019.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan K Richmond
- Division of General Surgery, West Virginia University - Charleston Division, Charleston, WV.
| | - Crystal Totten
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, University of Kentucky, Lexington, KY
| | - John Scott Roth
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Center for Advanced Training and Simulation, University of Kentucky, Lexington, KY
| | - Jonathon Tsai
- Charleston Area Medical Center, West Virginia University - Charleston Division, Charleston, WV
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Huerta S, Timmerman C, Argo M, Favela J, Pham T, Kukreja S, Yan J, Zhu H. Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Outcomes and Predictors of Complications. J Surg Res 2019; 241:119-127. [PMID: 31022677 DOI: 10.1016/j.jss.2019.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/20/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The robotic approach to an inguinal hernia has not been compared head to head with the open and laparoscopic techniques in randomized controlled trials. Furthermore, long-term outcomes for robotic inguinal hernia repair (RHR) are lacking. In this study, we compared laparoscopic inguinal hernia repair (LHR) and RHR with open inguinal hernia repair (OHR) in veteran patients performed by surgeons most familiar with each approach. METHODS A retrospective single-institution analysis of 1299 inguinal hernia repairs performed at the VA North Texas Health Care System between 2005 and 2017 was undertaken. Three surgeons performed the operations, each an expert in one approach, and there was no crossover in techniques. A total of 1100 OHRs, 128 LHRs, and 71 RHRs were performed. Univariable analysis was undertaken to determine associations between techniques and outcomes (OHR versus LHR; OHR versus RHR; LHR versus RHR). Setting complications as a dependent variable, multivariable analyses were undertaken to determine an association with complications as well as independent predictors of complications. RESULTS Patient demographics were similar among groups except for age that was higher in the OHR cohort. The average follow-up was 5.2 ± 3.4 y. In the present report, recurrence was associated with a higher rate in the RHR versus OHR (5.6% versus 1.7%; P < 0.02), but not in the LHR versus OHR (3.9% versus 1.9%; P = 0.09). Inguinodynia was more likely to occur in both the LHR and RHR compared with the OHR (9.4% and 14.1 versus 1.5%; both P's < 0.001). Urinary retention was also more common in the LHR and RHR than in the OHR (5.5% and 5.6% versus 1.8%, both P's < 0.05) as was the rate of overall complications (34.4% and 38.0% versus 11.2%, both P's < 0.001). Multivariable regression analysis showed femoral hernias, ASA, serum albumin, operative room time, a recurrent hernia, and the minimally invasive approaches were independent predictors of overall complications. CONCLUSIONS Outcomes in the OHR cohort were, in general, superior compared with both the LHR and RHR. However, these strategies should be viewed as complementary. The best approach to an inguinal hernia repair rests on the specific expertise of the surgeon.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
| | - Corey Timmerman
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas
| | - Thai Pham
- Department of Surgery, University of Texas Southwestern, Medical Center, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Sachin Kukreja
- Department of Surgery, VA North Texas Health Care System, Dallas, Texas
| | - Jingsheng Yan
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Hong Zhu
- Department of Surgery, University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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15
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Blatnik JA, Michael Brunt L. Controversies and Techniques in the Repair of Abdominal Wall Hernias. J Gastrointest Surg 2019; 23:837-845. [PMID: 30338444 DOI: 10.1007/s11605-018-3989-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
Abdominal wall hernia repair is one of the most common operations done by general surgeons today. Patients with incisional hernias can be extremely challenging to manage due to a number of factors that include obesity, prior hernia repairs, previous mesh placement, loss of domain, and other variables. The approach to patients with incisional hernias has evolved considerably over the last 20 years due to both advances in mesh technology and surgical approaches. Key factors in a successful outcome include modification of risk factors prior to surgery such as smoking cessation and weight reduction, selection of mesh appropriate to the hernia type and planned location of the mesh, and broad overlap of mesh beyond the margins of the hernia defect. Newer techniques such as transabdominis release and component separation with retrorectus mesh placement and robotic approaches to abdominal wall hernia are being increasingly utilized in these patients. This article reviews these aspects of abdominal wall hernia repair with a discussion of recent results and the importance of quality improvement and monitoring of outcomes.
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Affiliation(s)
- Jeffrey A Blatnik
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 S Euclid Ave., Box 8109, St. Louis, MO, 63110, USA
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, 660 S Euclid Ave., Box 8109, St. Louis, MO, 63110, USA.
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16
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Tam V, Rogers DE, Al-Abbas A, Borrebach J, Dunn SA, Zureikat AH, Zeh HJ, Hogg ME. Robotic Inguinal Hernia Repair: A Large Health System's Experience With the First 300 Cases and Review of the Literature. J Surg Res 2018; 235:98-104. [PMID: 30691857 DOI: 10.1016/j.jss.2018.09.070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/20/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the past 5 y, robotic surgery has expanded within general surgery, especially in regard to hernia repairs. We aimed to evaluate the outcomes of the early experience of over 300 consecutive robotic inguinal hernia repairs performed in an academic multihospital system. METHODS Consecutive robotic inguinal hernia repairs performed between December 2015 and June 2017 were analyzed. Retrospective chart review was performed, and hospital records were queried. Descriptive statistics were performed. A surgical learning curve case study is presented, breakdown of operative time is delineated, and review of the literature performed. RESULTS Over a period of 19 mo, 335 robotic inguinal hernia repairs were performed across seven hospitals by 18 surgeons. The mean patient age was 59 y (standard deviation [SD] 14), 93% were male, and the mean body mass index was 27 (SD 4.6). Bilateral hernia repairs were performed on 131 patients (39%). The mean operative time was 102 min (SD 38) and a resident or fellow trainee was present in the operating room for 119 cases (36%). Minor postoperative complications occurred in 54 patients (16%), including 14 with urinary retention (4.2%) and 13 with scrotal swelling (3.9%). The learning curve of the first adopted surgeon was 11-12 cases. CONCLUSIONS In the largest case series of robotic inguinal hernia repairs to date reporting short-term outcomes, early experience in an academic multihospital system produced safe outcomes including no open conversions, reoperations, and one readmission. In addition, the learning curve is manageable showing improvement in operating time with experience.
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Affiliation(s)
- Vernissia Tam
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Devin E Rogers
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr Al-Abbas
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jeffrey Borrebach
- Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stefanie A Dunn
- Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa E Hogg
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Charles EJ, Mehaffey JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z. Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc 2018; 32:2131-2136. [PMID: 29067575 PMCID: PMC10740385 DOI: 10.1007/s00464-017-5911-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 10/03/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair. METHODS All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U. RESULTS A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39-62], Lap: 57 [45-67], and Open: 56 [48-67] years, p = 0.03). Operative duration was also different (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] min, p < 0.001). There were no operative mortalities and all patients except one were discharged home the same day. Postoperative occurrences (adverse events, readmissions, and death) were similar between groups (Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942-8375] vs. Lap: $4527 [$2310-6003] vs. Open: $4264 [$3277-5143], p < 0.001). CONCLUSIONS Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA.
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Carlos A Tache-Leon
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Peter T Hallowell
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Robert G Sawyer
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA
| | - Zequan Yang
- Department of Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22903, USA
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18
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Robotic repair of symptomatic Spigelian hernias: a series of three cases and surgical technique review. J Robot Surg 2017; 12:557-560. [DOI: 10.1007/s11701-017-0742-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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Kolachalam R, Dickens E, D'Amico L, Richardson C, Rabaza J, Gamagami R, Gonzalez A. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc 2017. [PMID: 28646321 DOI: 10.1007/s00464-017-5665-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive inguinal hernia repair (IHR) in general and particularly in obese patients has not been widely adopted, potentially due to the perceived technical challenges and the well-documented learning curve associated with laparoscopic repair. Outcomes in robotic-assisted IHR in obese (BMI ≥ 30 kg/m2) patients have not been described and warrant study. METHODS Seven surgeons conducted a multicenter retrospective chart review of their early robotic-assisted IHR (RHR) cases and compared them with their open IHR (OHR) cases. Demographics, operative characteristics, and perioperative morbidity were compared for unadjusted and propensity-matched populations. RESULTS 651 robotic-assisted cases and 593 open cases were collected. The outcomes of 148 RHRs to 113 OHRs in obese patients were compared. For obese populations-whether unadjusted (robotic-assisted, n = 148; open, n = 113) or matched (1:1) (robotic-assisted, n = 95; open, n = 93)-the robotic-assisted and open cohorts were comparable in terms of demographics and baseline characteristics. Significantly higher percentages of OHR patients experienced postoperative complications post-discharge (unadjusted: 11.5% vs. 2.7%, p = 0.005; and matched: 10.8% vs. 3.2%, p = 0.047). More concomitant procedures and bilateral repairs were conducted in obese RHR patients than in obese OHR patients (unadjusted 29.7% vs. 16.8%, p = 0.019; and unadjusted 35.1% vs. 11.5%, p < 0.0001-respectively). Prior laparoscopic IHR experience did not affect 30-day outcomes. CONCLUSIONS Obese patients who undergo RHR have a lower rate of postoperative complications compared to obese patients who undergo OHR. Previous laparoscopic IHR experience, more bilateral repairs, and more concomitant procedures were not associated with increased complications in RHR patients. These outcomes may facilitate increased adoption of minimally invasive IHR approaches in the obese population.
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Affiliation(s)
- Ramachandra Kolachalam
- Department of Surgery, Providence-Providence Park Hospital, 26850, Providence Pkwy, Suite 460, Novi, MI, 48374, USA.
| | - Eugene Dickens
- Hillcrest Medical Center and Oklahoma Physician Group, Tulsa, OK, USA
| | - Lawrence D'Amico
- ValleyCare Health System of Ohio, Trumbull Memorial Hospital, Warren, OH, USA
| | | | - Jorge Rabaza
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | | | - Anthony Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
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20
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Donkor C, Gonzalez A, Gallas MR, Helbig M, Weinstein C, Rodriguez J. Current perspectives in robotic hernia repair. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:57-67. [PMID: 30697564 PMCID: PMC6193421 DOI: 10.2147/rsrr.s101809] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The surgical treatment of hernias has developed throughout the evolution of surgery. The fascination with hernia surgery is in part driven by its prevalence and by the variety of treatment options. Minimally invasive hernia surgery has a goal of a robust repair with minimal complications, and new robotic techniques are being developed in complex abdominal wall hernias with promising results. This review focuses on inguinal, ventral, and incisional hernias and their outcomes with a discussion on the traditional open, laparoscopic, and robotic techniques. The prevalence of minimally invasive hernia surgery and its advantages are also outlined. We highlight our experience in these procedures, specifically robotic herniorrhaphy, as it pertains to ventral incisional and inguinal hernia repair. We conclude that the robotic platform is proving to be a benefit to hernia repair. Many studies are showing its feasibility and comparable results to standard laparoscopy, and some have shown improved results, including shorter hospital stay without significant increases in cost. The robotic option of hernia repair has resulted in an increase in minimally invasive hernia repair, a number that has remained stagnant for the last decade. With more surgeons gaining training and experience and greater availability of the robotic platform, we expect to see greater numbers of minimally invasive hernia repair.
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Affiliation(s)
- Charan Donkor
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA, .,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA,
| | - Anthony Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA, .,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA,
| | - Michelle R Gallas
- Population Health and Outcomes Research, Center for Research and Grants, Baptist Health South Florida, Miami, FL, USA
| | - Michael Helbig
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA,
| | - Corey Weinstein
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA,
| | - Jaime Rodriguez
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA,
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21
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Oviedo RJ, Robertson JC, Alrajhi S. First 101 Robotic General Surgery Cases in a Community Hospital. JSLS 2016; 20:JSLS.2016.00056. [PMID: 27667913 PMCID: PMC5027890 DOI: 10.4293/jsls.2016.00056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.
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Affiliation(s)
- Rodolfo J Oviedo
- Capital Regional Surgical Associates, 2626 Care Drive, Suite 206, Tallahassee, FL 32308, USA
| | - Jarrod C Robertson
- Florida State University College of Medicine, Medical Class of 2017, 1115 W Call St, Tallahassee, FL 32304, USA
| | - Sharifah Alrajhi
- Florida State University Department of Statistics, 117 N Woodward Ave, Tallahassee, FL 32306, USA
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