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Vogel R, Heinzelmann F, Büchler P, Mück B. [Roboticassisted incisional hernia surgery-Retromuscular techniques]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:27-33. [PMID: 38051317 DOI: 10.1007/s00104-023-01998-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
The trend to minimally invasive surgery has also made its way into the surgical treatment of incisional hernias. Unlike other areas of visceral surgery, recent years have seen a resurgence of open sublay repair in incisional hernia procedures, primarily due to the recognition of the retromuscular layer as the optimal mesh placement site. Additionally, with the growing availability of robotic systems in visceral surgery, these procedures are increasingly being offered in the form of minimally invasive procedures. These methods can be categorized based on the access routes: robotic-assisted transperitoneal procedures (e.g., r‑Rives, r‑TARUP, r‑TAR) and total extraperitoneal hernia repair (e.g., r‑eTEP, r‑eTAR). Notably, the introduction of transversus abdominis muscle release enables the robotic-assisted treatment of larger and more complex hernia cases with complete fascial closure. With respect to the comparison with open surgery required in retromuscular hernia treatment, the currently available literature on incisional hernia repair seems to show initial advantages of robotic-assisted surgery in the perioperative course. New technologies create new possibilities. In the context of surgical training the use of surgical robot systems with double consoles opens up completely new perspectives. Furthermore, the robot enables the implementation of models of artificial intelligence and augmented reality and could therefore open up novel dimensions in surgery.
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Affiliation(s)
- R Vogel
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - F Heinzelmann
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - P Büchler
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland
| | - Björn Mück
- Klinik für Allgemein‑, Viszeral‑ und Kinderchirurgie, Hernienzentrum Kempten - Allgäu, Klinikverbund Allgäu gGmbH, Klinikum Kempten, Robert-Weixler-Straße 50, 87439, Kempten (Allgäu), Deutschland.
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Dietz UA, Kudsi OY, Garcia-Ureña M, Baur J, Ramser M, Maksimovic S, Keller N, Dörfer J, Eisner L, Wiegering A. Robotic hernia repair III. English version : Robotic incisional hernia repair with transversus abdominis release (r‑TAR). Video report and results of a cohort study. Chirurg 2021; 92:28-39. [PMID: 34495358 PMCID: PMC8695562 DOI: 10.1007/s00104-021-01500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.
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Affiliation(s)
- Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland.
| | - O Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., 02301, Brockton, MA, USA
| | - Miguel Garcia-Ureña
- Hospital Universitario del Henares, Universidade Francisco de Vitoria, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Johannes Baur
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Michaela Ramser
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Sladjana Maksimovic
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Nicola Keller
- Department of General, Visceral and Vascular Surgery, Cantonal Hospital Baden, Im Engel 1, 5404, Baden, Switzerland
| | - Jörg Dörfer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstrasse 150, 4600, Olten, Switzerland
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
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