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Hayakawa T, Ueno N, Eguchi T, Kawarada Y, Shigemitsu Y, Shimada G, Suwa K, Nakagawa M, Hachisuka T, Hayakawa S, Yamamoto K, Yokoyama T, Wada N, Wada H, Takehara H, Nagae I, Morotomi Y, Idani H, Saijo F, Tsuruma T, Nakano K, Kimura T, Matsumoto S. Practice guidelines on endoscopic surgery for qualified surgeons by the endoscopic surgical skill qualification system: Hernia. Asian J Endosc Surg 2024; 17:e13363. [PMID: 39087456 DOI: 10.1111/ases.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Affiliation(s)
| | - Nozomi Ueno
- Hernia Center, Saiseikai Suita Hospital, Toyota, Japan
| | - Toru Eguchi
- Department of Surgery, Harasanshin Hospital, Toyota, Japan
| | - Yo Kawarada
- Department of Surgery, Tonan Hospital, Toyota, Japan
| | | | - Gen Shimada
- Hernia Center, St. Luke's International Hospital, Toyota, Japan
| | - Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Toyota, Japan
| | | | | | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Toyota, Japan
| | - Kaisuke Yamamoto
- Department of Surgery, Inguinal Hernia Surgery Center, Kenseikai Ken Clinic, Toyota, Japan
| | | | - Norihito Wada
- Department of Surgery, Shonan Keiiku Hospital, Toyota, Japan
| | - Hidetoshi Wada
- Department of Surgery, Shimada General Medical Center, Toyota, Japan
| | - Hiroo Takehara
- Department of Hernia Surgery, Okinawa Heart-Life Hospital, Toyota, Japan
| | - Itsuro Nagae
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Toyota, Japan
| | | | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Fumito Saijo
- Department of Surgery, Tohoku University Hospital, Toyota, Japan
| | | | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Toyota, Japan
| | - Taizo Kimura
- Department of Surgery, Fujinomiya City General Hospital, Toyota, Japan
| | - Sumio Matsumoto
- National Hospital Organization, Tokyo Medical Center, Toyota, Japan
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Sadava EE, Laxague F, Valinoti AC, Angeramo CA, Schlottmann F. Outcomes after open posterior component separation via transversus abdominis release (TAR) for incisional hernia repair. A systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03142-5. [PMID: 39192038 DOI: 10.1007/s10029-024-03142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR. METHODS We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies. RESULTS A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies. CONCLUSION Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients' selection and optimization to improve outcomes.
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Affiliation(s)
- Emmanuel E Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina.
- Division of Abdominal Wall Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
| | - Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina
| | - Agustin C Valinoti
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina
- Division of Abdominal Wall Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, Buenos Aires, C1118AAT, Argentina
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Turcotte J, Connors K, Park N, Kim P, Belyansky I. Outcomes of Transversus Abdominis Release With Macroporous Polypropylene Mesh. J Surg Res 2024; 300:141-149. [PMID: 38810527 DOI: 10.1016/j.jss.2024.04.072] [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: 10/27/2023] [Revised: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Transversus abdominis release (TAR) is increasingly being performed for reconstruction of complex incisional and recurrent ventral hernias, with complication rates ranging from 17.4% to 33.3% after open TAR (oTAR) or robotic TAR (rTAR). The purpose of this study was to describe the outcomes of patients undergoing TAR with macroporous polypropylene mesh (MPM) and to compare outcomes between oTAR and rTAR. METHODS A retrospective review of 183 consecutive patients undergoing TAR with MPM performed by a single surgeon at a single institution from 2015 to 2021 was performed. Patients with less than one year of follow-up were excluded. Univariate analysis was performed to compare outcomes between oTAR and rTAR patients. RESULTS Average patient age was 59.4 y, median body mass index was 33.2 kg/m2, and median hernia width was 12.0 cm. Forty 2 (23%) patients underwent oTAR, 127 (69%) underwent rTAR, and 14 (8%) underwent laparoscopic TAR. Patients experienced 16.4%, 10.4%, 3.8%, and 6.0% rates of overall complications, surgical site occurrences, surgical site infections, and other complications, respectively. At average follow-up of 2.3 y, a 2.7% hernia recurrence rate was observed. In comparison to patients undergoing oTAR, rTAR patients required shorter operative times and length of stay, and were less likely to experience postoperative complications overall, and other complications. Recurrence rates were similar between oTAR and rTAR. CONCLUSIONS Patients undergoing TAR with MPM experienced complication and recurrence rates in alignment with previously published results. In comparison to oTAR, rTAR was associated with more favorable perioperative outcomes and complication rates, but similar recurrence rates.
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Affiliation(s)
- Justin Turcotte
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland.
| | - Kevin Connors
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland
| | - Nigel Park
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland
| | - Paul Kim
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland
| | - Igor Belyansky
- Department of Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland
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Lenkov V, Beffa LRA, Miller BT, Maskal SM, Ellis RC, Tu C, Krpata DM, Rosen MJ, Prabhu AS, Petro CC. Postoperative bleeding after complex abdominal wall reconstruction: A post hoc analysis of a randomized clinical trial. Surgery 2024; 176:148-153. [PMID: 38641542 DOI: 10.1016/j.surg.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/12/2024] [Accepted: 03/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Abdominal wall reconstruction requires extensive dissection of the abdominal wall, exposure of the retroperitoneum, and aggressive chemoprophylaxis to reduce the risk of thromboembolic complications. The need for early anticoagulation puts patients at risk for bleeding. We aimed to quantify postoperative blood loss, incidence of transfusion and reoperation, and associated risk factors in patients undergoing complex abdominal wall reconstruction. METHODS All patients underwent a posterior component separation with transversus abdominis release and placement of retromuscular mesh for ventral hernias <20 cm wide and were enrolled in a clinical trial assessing the utility of trans-fascial mesh fixation. A post hoc analysis was performed to quantify postoperative hemoglobin drop, blood transfusions, and procedural interventions for ongoing bleeding during the first 30 postoperative days. Multivariate logistic regression was used to identify predictors of transfusion. RESULTS In 325 patients, hemoglobin decreased by 3.61 (±1.58) g/dL postoperatively. Transfusion incidence was 9.5% (n = 31), and 3.1% (n = 10) required a surgical intervention for bleeding. Initiation of therapeutic anticoagulation postoperatively resulted in a higher likelihood of requiring surgical intervention for bleeding (odds ratio 10.4 [95% confidence interval 2.75-43.8], P < .01). Use of perioperative therapeutic anticoagulation was associated with higher rates of transfusion (odds ratio 3.51 [95% confidence interval 1.34-8.53], P < .01). Neither intraoperative blood loss nor operative times were associated with an increased transfusion requirement or need for operative intervention. CONCLUSION Patients undergoing transversus abdominis release are at a high risk of postoperative bleeding that can require transfusion and reoperation. Patients requiring postoperative therapeutic anticoagulation are at particularly high risk.
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Affiliation(s)
- Vyacheslav Lenkov
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH.
| | - Lucas R A Beffa
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Benjamin T Miller
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Sara M Maskal
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Ryan C Ellis
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Chao Tu
- Department of Statistics, Cleveland Clinic Foundation, OH
| | - David M Krpata
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Michael J Rosen
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Ajita S Prabhu
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
| | - Clayton C Petro
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, OH
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Awad L, Reed B, Bollen E, Langridge BJ, Jasionowska S, Butler PEM, Ponniah A. The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:254. [PMID: 38878229 PMCID: PMC11180031 DOI: 10.1007/s11701-024-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/19/2024] [Indexed: 06/19/2024]
Abstract
The role of robotics has grown exponentially. There is an active interest amongst practitioners in the transferability of the potential benefits into plastic and reconstructive surgery; however, many plastic surgeons report lack of widespread implementation, training, or clinical exposure. We report the current evidence base, and surgical opportunities, alongside key barriers, and limitations to overcome, to develop the use of robotics within the field. This systematic review of PubMed, Medline, and Embase has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PROSPERO (ID: CRD42024524237). Preclinical, educational, and clinical articles were included, within the scope of plastic and reconstructive surgery. 2, 181, articles were screened; 176 articles met the inclusion criteria across lymph node dissection, flap and microsurgery, vaginoplasty, craniofacial reconstruction, abdominal wall reconstruction and transoral robotic surgery (TOR). A number of benefits have been reported including technical advantages such as better visualisation, improved precision and accuracy, and tremor reduction. Patient benefits include lower rate of complications and quicker recovery; however, there is a longer operative duration in some categories. Cost presents a significant barrier to implementation. Robotic surgery presents an exciting opportunity to improve patient outcomes and surgical ease of use, with feasibility for many subspecialities demonstrated in this review. However, further higher quality comparative research with careful case selection, which is adequately powered, as well as the inclusion of cost-analysis, is necessary to fully understand the true benefit for patient care, and justification for resource utilisation.
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Affiliation(s)
- Laura Awad
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK.
- Department of Plastic Surgery, Royal Free Hospital, London, UK.
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK.
| | - Benedict Reed
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Edward Bollen
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
| | - Benjamin J Langridge
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Sara Jasionowska
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Peter E M Butler
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
- Department of Surgery and Interventional Sciences, University College London, Royal Free Hospital, London, UK
| | - Allan Ponniah
- Charles Wolfson Centre of Reconstructive Surgery, University College London, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
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Quezada N, Irarrazaval MJ, Chen DC, Grimoldi M, Pimentel F, Crovari F. Robotic transversus abdominis release using HUGO RAS system: our initial experience. Surg Endosc 2024; 38:3395-3404. [PMID: 38719985 DOI: 10.1007/s00464-024-10865-0] [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: 12/22/2023] [Accepted: 04/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). METHODS All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. RESULTS Ten patients were included in this study. The median BMI was 31 (21-40.6) kg/m2. The median height was 1.6 m (1.5-1.89 m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1-6) days. CONCLUSION Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team.
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Affiliation(s)
- Nicolas Quezada
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile.
| | | | - David C Chen
- Lichtenstein Amid Hernia Institute at University of California, Los Angeles, USA
| | - Milenko Grimoldi
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Región Metropolitana, Santiago, Chile
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Sabbatini F, La Regina D, Murgante Testa N, Senatore AM, Saporito A, Pini R, Mongelli F. Hospital costs of robotic-assisted and open treatment of large ventral hernias. Sci Rep 2024; 14:11523. [PMID: 38769410 PMCID: PMC11106311 DOI: 10.1038/s41598-024-62550-w] [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: 02/21/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024] Open
Abstract
Robotic-assisted treatment of ventral hernia offers many advantages, however, studies reported higher costs for robotic surgery compared to other surgical techniques. We aimed at comparing hospital costs in patients undergoing large ventral hernia repair with either robotic or open surgery. We searched from a prospectively maintained database patients who underwent robotic or open surgery for the treatment of the large ventral hernias from January 2016 to December 2022. The primary endpoint was to assess costs in both groups. For eligible patients, data was extracted and analyzed using a propensity score-matching. Sixty-seven patients were retrieved from our database. Thirty-four underwent robotic-assisted surgery and 33 open surgery. Mean age was 66.4 ± 4.1 years, 50% of patients were male. After a propensity score-matching, a similar total cost of EUR 18,297 ± 8,435 vs. 18,024 ± 7514 (p = 0.913) in robotic-assisted and open surgery groups was noted. Direct and indirect costs were similar in both groups. Robotic surgery showed higher operatory theatre-related costs (EUR 7532 ± 2,091 vs. 3351 ± 1872, p < 0.001), which were compensated by shorter hospital stay-related costs (EUR 4265 ± 4366 vs. 7373 ± 4698, p = 0.032). In the treatment of large ventral hernia, robotic surgery had higher operatory theatre-related costs, however, they were fully compensated by shorter hospital stays and resulting in similar total costs.
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Affiliation(s)
- Flaminia Sabbatini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland
| | - Nicole Murgante Testa
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Anna Maria Senatore
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Andrea Saporito
- Department of Anesthesia, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland.
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Tryliskyy Y, Kebkalo A, Tyselskyi V, Owais A, Pournaras DJ. Short-term outcomes of minimally invasive techniques in posterior component separation for ventral hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03030-y. [PMID: 38632220 DOI: 10.1007/s10029-024-03030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes. METHODS A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions. RESULTS There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively. CONCLUSIONS Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.
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Affiliation(s)
- Y Tryliskyy
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK.
- The University of Edinburgh, Edinburgh, UK.
| | - A Kebkalo
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - V Tyselskyi
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - A Owais
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK
| | - D J Pournaras
- Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
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Carter J, Ahamed F, Juprasert J, Anderson M, Lin M, Lebares C, Soriano I. Robotic repair of moderate-sized midline ventral hernias reduced complications, readmissions, and length of hospitalization compared to open techniques. J Robot Surg 2024; 18:142. [PMID: 38554231 DOI: 10.1007/s11701-024-01909-7] [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: 02/08/2024] [Accepted: 03/09/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias. METHODS From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3-10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien-Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications. RESULTS Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17, = 0.049). In regression models, only open technique predicted complications. CONCLUSIONS Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
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Affiliation(s)
- Jonathan Carter
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA.
| | - Fayyaz Ahamed
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Jackly Juprasert
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Mark Anderson
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Matthew Lin
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Carter Lebares
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
| | - Ian Soriano
- Department of Surgery, University of California, San Francisco, 521 Parnassus Ave, HSW 1601, San Francisco, CA, 94143, USA
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Ivakhov GB, Kalinina AA, Andriyashkin AV, Titkova SM, Loban KM, Glagolev NS, Sazhin AV. Comparison of open and endoscopic posterior component separation with transversus abdominis release: a propensity score-matched study. Hernia 2024:10.1007/s10029-024-02964-7. [PMID: 38367096 DOI: 10.1007/s10029-024-02964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Posterior component separation with transversus abdominis release (TAR) is considered to be the optimal technique for large incisional ventral hernia repair. Endoscopic TAR (eTAR) that gets all the benefits of minimally invasive surgery (MIS) gives a possibility to enhance results of the treatment. The aim of our study was to make the comparison between open and endoscopic TAR procedures with an emphasis on frequency and severity of postoperative complications in comparable groups. MATERIALS AND METHODS All patients had midline incisional hernia and underwent either open (open TAR group) or endoscopic (eTAR group) Rives-Stoppa repair in combination with bilateral transversus abdominis release in Moscow City Hospital №1 from January 2018 to December 2022. A propensity score matching (PSM) was used to make groups comparable. Postoperative complications were classified according to Clavien-Dindo Classification, and Comprehensive complication index was calculated. RESULTS We performed 133 open and endoscopic TAR separation for midline incisional hernia. After PSM analysis 51 patients were matched to each group. Overall surgical morbidity in the open TAR group (56.9%) was statistically significantly higher than in the eTAR group (29.4%) (p = 0.009). There were more severe complications (Clavien IIIa-V) in the open TAR group (11.8% vs. 0%, p = 0.027). Length of hospital stay after surgery was shorter in eTAR group (p < 0.001). The Comprehensive complication index in the open TAR group was significantly higher than in eTAR group, 8.7 (0-20.9) vs. 0 (0-8.7) (p = 0.011). CONCLUSION Based on the data from our study, the entire MIS procedure including endoscopic TAR is a safe and optimal technique for surgery of midline incisional ventral hernia, requiring TAR separation in terms of reducing the rate of postoperative complications, their severity and hospital length of stay, compared to open TAR procedure.
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Affiliation(s)
- G B Ivakhov
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997.
| | - A A Kalinina
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - A V Andriyashkin
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - S M Titkova
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - K M Loban
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - N S Glagolev
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
| | - A V Sazhin
- Pirogov Russian National Research Medical University, 1, Ostrovityanov Str., Moscow, Russia, 117997
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11
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Lomanto D, Tan L, Lee S, Wijerathne S. Robotic Platform: What It Does and Does Not Offer in Hernia Surgery. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2024; 3:12701. [PMID: 38425788 PMCID: PMC10899468 DOI: 10.3389/jaws.2024.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Davide Lomanto
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
| | - Lydia Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Lee
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sujith Wijerathne
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Surgery, Alexandra Hospital (National University Health System), Singapore, Singapore
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12
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Tran E, Sun J, Gundara J. Systematic review of robotic ventral hernia repair with meta-analysis. ANZ J Surg 2024; 94:37-46. [PMID: 38087977 DOI: 10.1111/ans.18822] [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: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND Despite being one of the most common operations performed by general surgeons, there is a lack of consensus regarding the recommended approach for ventral hernia repair (VHR). Recent times have seen the rapid development of new techniques, such as robotic ventral hernia repair (RVHR). This systematic review and meta-analysis aims to evaluate the currently available evidence relating to RVHR, in comparison to open VHR (OVHR) and laparoscopic VHR (LVHR). METHODS A systematic search of the following databases was conducted: PubMed, Embase, Scopus and Web of Science. A meta-analysis was performed for the outcomes of length of stay (LOS), recurrence, operative time, intraoperative complications, wound complications, 30-day readmission, 30-day reoperation, mortality and costs. RESULTS A total of 39 studies met inclusion criteria. Overall, RVHR reduced LOS, intra-operative complications, wound complications and readmission compared to OVHR. Compared to LVHR, RVHR was associated with increased operative time and costs, with comparable clinical outcomes. CONCLUSION There is currently a lack of robust evidence to support the robotic approach in VHR. It does not demonstrate major benefits in comparison to LVHR, which is more affordable and accessible. Strong quality, long-term data is required to help with establishing a gold standard approach in VHR.
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Affiliation(s)
- Elisa Tran
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Justin Gundara
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Department of General Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Department of General Surgery, Redland Hospital, Cleveland, Queensland, Australia
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13
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Marckmann M, Krarup PM, Henriksen NA, Christoffersen MW, Jensen KK. Enhanced recovery after robotic ventral hernia repair: factors associated with overnight stay in hospital. Hernia 2024; 28:223-231. [PMID: 37668820 PMCID: PMC10891254 DOI: 10.1007/s10029-023-02871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) protocols lead to reduced post-operative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal post-operative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify factors associated with overnight stay in hospital, as well as patient-reported pain levels in the immediate post-operative period. METHODS This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first 3 post-operative days and pre- and 30-day post-operative hernia-related quality of life, using the EuraHS questionnaire. RESULTS A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (robotic transabdominal retromuscular umbilical prosthetic hernia repair) (60.6%) followed by bilateral roboTAR (robotic transversus abdominis release) (19.3%). The mean horizontal fascial defect was 4.8 cm, and the mean duration of surgery was 141 min. In total, 78 (71.6%) patients were discharged on the day of surgery, and factors associated with overnight stay were increasing fascial defect area, longer duration of surgery, and transverse abdominis release. There was no association between post-operative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001). CONCLUSION An ERAS protocol after RVHR was associated with a high rate of outpatient procedures with low patient-reported pain levels.
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Affiliation(s)
- M Marckmann
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - N A Henriksen
- Department of hepatic and gastrointestinal diseases, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M W Christoffersen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - K K Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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14
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de'Angelis N, Schena CA, Moszkowicz D, Kuperas C, Fara R, Gaujoux S, Gillion JF, Gronnier C, Loriau J, Mathonnet M, Oberlin O, Perez M, Renard Y, Romain B, Passot G, Pessaux P. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc 2024; 38:24-46. [PMID: 37985490 DOI: 10.1007/s00464-023-10545-5] [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: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. METHODS PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. RESULTS Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95 mL), shorter LOS (- 3.4 day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. CONCLUSION These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
- Faculty of Medicine, University of Paris Cité, Paris, France.
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| | - David Moszkowicz
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
| | | | - Régis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Muriel Mathonnet
- Department of General, Endocrine and Digestive Surgery, University Hospital of Limoges, Limoges, France
| | - Olivier Oberlin
- Service de Chirurgie, Groupe Hospitalier Privé Ambroise-Paré - Hartmann, Paris, France
| | - Manuela Perez
- Département de chirurgie viscérale, métabolique et cancérologie (CVMC), CHRU de Nancy-hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Yohann Renard
- Departement of General Surgery, Reims Champagne-Ardenne University, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Passot
- Department of Surgical Oncology, Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Patrick Pessaux
- Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
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15
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Maskal S, Beffa L. The Role of Robotics in Abdominal Wall Reconstruction. Surg Clin North Am 2023; 103:977-991. [PMID: 37709400 DOI: 10.1016/j.suc.2023.04.007] [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] [Indexed: 09/16/2023]
Abstract
Robotic abdominal wall reconstruction is becoming an accepted technique to approach complex hernias in a minimally invasive fashion. There remain a deficit of high-quality data to suggest significant clinical benefit but current randomized trials are ongoing. Robotic surgery can be applied to a range of abdominal wall defects safely and with positive outcomes which are at least equivocal to open abdominal wall techniques.
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Affiliation(s)
- Sara Maskal
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lucas Beffa
- Lerner College of Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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16
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Kudsi OY, Kaoukabani G, Friedman A, Bahadir J, Bou-Ayash N, Vallar K, Gokcal F. Impact of COVID-19 on clinical outcomes of robotic inguinal hernia repair. Hernia 2023; 27:1109-1113. [PMID: 36692610 PMCID: PMC9872748 DOI: 10.1007/s10029-023-02746-7] [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: 11/29/2022] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the impact of the COVID-19 pandemic on the clinical impact of the clinical outcomes of robotic inguinal hernia repair. METHODS Patients who underwent RIHR 2 years before and after March 10, 2020, were included in this retrospective study and assigned accordingly to the pre- or post-COVID group. Pre-, intra-, and postoperative variables including patients' demographics, hernia characteristics, complications, and hernia recurrence rates were compared between groups. RESULTS 183 (94.5% male) and 141 (96.4% male) patients were assigned to the pre- and post-COVID groups, respectively. Patient demographics and medical comorbidities did not differ between groups. Operative time was approximately 40 min longer in the post-COVID group (p < 0.001) with higher rates of bilateral IHR (pre-COVID: 30.1% vs. post-COVID: 46.4%, p = 0.003). Mesh material differed between groups with predominance of polyester mesh in the pre-COVID group vs. polypropylene in the post-COVID one. Median hospital length of stay (LOS) was 0 days in both groups, and same-day discharge rates were 93.4% pre-pandemic and 92.8% post-pandemic (p = 0.09). There were no pulmonary complications recorded in either group or no cases of COVID-19 detected within two weeks postoperatively in the post-COVID group. Seromas were more frequent in the post-COVID group (pre-COVID: 2 vs. post-COVID: 8, p = 0.018) and no hernia recurrences were recorded. CONCLUSION This is the first study to describe the impact of COVID-19 on RIHR. Clinical outcomes and hernia-specific complications were not impacted by the COVID-19 pandemic.
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Affiliation(s)
- O Y Kudsi
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - G Kaoukabani
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
| | | | - J Bahadir
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
| | | | - K Vallar
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
| | - F Gokcal
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
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17
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Kudsi OY, Kaoukabani G, Bou-Ayash N, Gokcal F. Does smoking influence the clinical outcomes of robotic ventral hernia repair? A propensity score matching analysis study. J Robot Surg 2023; 17:2229-2236. [PMID: 37285002 DOI: 10.1007/s11701-023-01645-4] [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: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
The purpose of this study is to compare the clinical outcomes of robotic ventral hernia repair (RVHR) between smokers and non-smokers. Data for patients undergoing RVHR between 2012 and 2022 were collected. Patients were assigned to either smoking (+) or smoking (-) groups, according to their smoking status in the last 3 months prior to their procedure. Pre-, intra- and postoperative variables including surgical site occurrences (SSO) and infections (SSI), and hernia recurrence were analyzed after a propensity score matching analysis based on the patients' demographics and hernia's characteristics. Each group consisted of 143 patients matched according to their preoperative characteristics. There were no differences in terms of demographics and hernia characteristics. Intraoperative complications occurred at a comparable rate between both groups (p = 0.498). Comprehensive Complication Index® and all complication grades of the Clavien-Dindo classification were similar between both groups. Surgical site occurrences and infections did not differ either [smoking (+) vs. smoking (-): 7.6% vs 5.4%, p = 0.472; 5 vs. 0, p = 0.060, respectively). Rates of SSOs and SSIs that required any intervention (SSOPI) were similar in both groups [smoking (+): 3.1% vs. smoking (-): 0.8%, p = 0.370]. With a mean follow-up of 50 months for the cohort, recurrences rates were also comparable with 7 recorded in the smoking (-) versus 5 in the smoking (+) group (p = 0.215). Our study showed comparable rates of SSOs, SSIs, SSOPIs, and recurrence between smokers and non-smokers following RVHR. Future studies should compare the open, laparoscopic, and robotic approaches in smokers.
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Affiliation(s)
- Omar Yusef Kudsi
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA.
- Tufts University School of Medicine, Boston, MA, USA.
| | - Georges Kaoukabani
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
| | | | - Fahri Gokcal
- Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA
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18
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Chen F, Yang H, Wang F, Zhu Y, Chen J. Outcomes of recurrent incisional hernia repair by open and laparoscopic approaches: a propensity score-matched comparison. Hernia 2023; 27:1289-1298. [PMID: 37526771 DOI: 10.1007/s10029-023-02833-9] [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] [Accepted: 06/30/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Recurrent incisional hernias are challenging, and their surgical outcomes have not been well studied. We aimed to analyze the outcomes of recurrent incisional hernia repair in a propensity score-matched cohort study on laparoscopic intra-peritoneal onlay mesh repair (lap. IPOM) versus open sublay repair. METHODS All consecutive patients who had undergone open sublay repair and lap. IPOM of recurrent incisional hernia between January 2015 and December 2021 at a tertiary hernia center was identified. One-to-one propensity score matching was used to achieve a balanced exposure groups at baseline. RESULTS Of 255 patients, 85/95 with open sublay repair were matched to 85/160 with lap. IPOM. Before matching, the open sublay group had significantly larger hernia defects (6.3 cm vs. 5.0 cm) than the lap. IPOM group. Other major baseline imbalances were also found in body mass index (BMI), obesity and European Hernia Society (EHS) width classification. The pre-match results showed that the lap. IPOM group had significantly shorter operative time (median 75 vs. 95 min) and shorter postoperative hospital stay (median 8 vs. 11 days) compared with the open sublay group. Wound infection (8.4% vs. 1.9%) and hematoma (5.3% vs. 0.6%) occurred more frequently after open sublay repair. After matching, baseline characteristics were well balanced. The recurrence rate and incidence of complications were comparable between the two groups. However, the post-match analysis still showed that lap. IPOM was associated with decreased length of postoperative stay. CONCLUSION The outcomes of recurrent incisional hernia surgery after lap. IPOM and open sublay repair appear similar, except that the former had shorter length of postoperative stay. However, the poor outcomes were more likely associated with the unfavorable risk profiles, such as larger defect size, rather than the procedure technique itself.
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Affiliation(s)
- F Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - H Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - F Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - Y Zhu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China
| | - J Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
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Ferraro L, Formisano G, Salaj A, Giuratrabocchetta S, Toti F, Felicioni L, Salvischiani L, Bianchi PP. Preliminary robotic abdominal wall reconstruction experience: single-centre outcomes of the first 150 cases. Langenbecks Arch Surg 2023; 408:276. [PMID: 37450034 DOI: 10.1007/s00423-023-03004-1] [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: 08/25/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Robotic surgery offers new possibilities in repairing complex hernias with a minimally invasive approach. This study aimed to analyze our preliminary results. METHODS Between November 2015 and February 2020, 150 patients underwent robotic reconstruction for abdominal wall defects (77 primary and 73 incisional). A retrospective analysis of a prospectively maintained database was conducted to evaluate the short-term outcomes. RESULTS The mean operative time was 176.9 ± 72.1 min. No conversion to open or laparoscopic approach occurred. The mean hospital length of stay was 2.6 ± 1.6. According to Clavien-Dindo classification, two (grade III) complications following retromuscular mesh placement (1.3%) occurred. One patient (0.7%) required surgical revision due to small bowel occlusion following an intraparietal hernia. The 30-day readmission rate was 0.6%, and the mortality was nihil. CONCLUSIONS Robotic surgery is valuable for safely completing challenging surgical procedures like complex abdominal wall reconstruction, with low conversion and complication rates. A stepwise approach to the different surgical techniques is essential to optimize the outcomes and maximize the benefits of the robotic approach.
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Affiliation(s)
- Luca Ferraro
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy.
| | - Giampaolo Formisano
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy
| | - Adelona Salaj
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy
| | - Simona Giuratrabocchetta
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy
| | - Francesco Toti
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy
| | - Luca Felicioni
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Lucia Salvischiani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paolo Pietro Bianchi
- Dipartimento di Scienze della Salute, Divion of Minimally-invasive and Robotic surgery, ASST Santi Paolo e Carlo, Università degli studi di Milano, Milan, Italy
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Kudsi OY, Kaoukabani G, Bou-Ayash N, Friedman A, Vallar K, Crawford AS, Gokcal F. A comparison of clinical outcomes and costs between robotic and open ventral hernia repair. Am J Surg 2023; 226:87-92. [PMID: 36740503 DOI: 10.1016/j.amjsurg.2023.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND As robotic ventral hernia repair(VHR) adoption increases, real-world evidence is needed to ensure appropriate utilization. METHODS Data for open and robotic VHR(OVHR, RVHR) was retrospectively analyzed. Outcomes and costs were compared via inverse probability treatment weighting using propensity scores to estimate the average treatment effect on the treated for RVHR. RESULTS 675 open and 609 robotic ventral hernia repairs were included. Demographics and hernia characteristics were comparable. Complications rates were lower in RVHR(p < 0.001). Clavien-Dindo grade-III complications were lower in RVHR(13.2% vs. 4.9%, p < 0.001). RVHR resulted in fewer surgical site events(21.5% vs. 12.2%, p < 0.001). Recurrence rates were greater in OVHR(8.9% vs. 2.8%, p < 0.001). The higher RVHR hospital costs (Δ = $2456, p = 0.005) were balanced by the lower post-discharge costs, compared to OVHR(Δ = $799, p = 0.023). Total costs did not differ(Δ = $1656 p = 0.081). CONCLUSION Although hospital costs were higher, post-discharge expenses favored RVHR due to the lower postoperative complications, which lead to comparable total costs to OVHR.
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Affiliation(s)
- Omar Yusef Kudsi
- Good Samaritan Medical Center, Brockton, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
| | | | | | | | - Kelly Vallar
- Good Samaritan Medical Center, Brockton, MA, USA
| | | | - Fahri Gokcal
- Good Samaritan Medical Center, Brockton, MA, USA
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21
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Irfan A, Cochrun S, He K, Okorji L, Parmar AD. Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis. Hernia 2023; 27:671-676. [PMID: 37160504 DOI: 10.1007/s10029-023-02794-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Over the past decade, an increase has been seen in robotics used for hernia repair, specifically robotic abdominal wall reconstruction (rAWR). However, the learning curve for rAWR can be steep and presently, little is understood regarding the optimal case volume required to achieve proficiency. The aim of our study was to review skill acquisition and describe the learning curve for rAWR. METHODS A retrospective, single-surgeon case series of consecutive patients who underwent rAWR from 2018 to 2022. The primary outcome was operative time, obtained from console time identified through the MyIntutive application. A one-sided cumulative sum analysis (CUSUM) curve for the total operative time was derived based on the mean operative time of chronological procedures (207 min). RESULTS 185 patients underwent rAWR between 2018 and 2022. These patients were more likely to be female, Caucasian, and have undergone two previous hernia repairs. ASA complexity increased over time with ASA 3 being predominant from 2020 onwards. The median hernia length was 15.0 cm and the median width was 7 cm. Average operative time was 207.8 min and decreased over time. The CUSUM analysis identified four phases of skill acquisition with the following case volumes: Initial Learning Curve (0-20), Stabilization Phase (21-55), Second Learning Curve (56-70), 4) Skill Proficiency (> 70). CONCLUSION In the early learning curve of rAWR, operative time decreased consistently after 70 cases, with an initial inflection after 20 cases. We identified varying stages of skill acquisition that are likely typical of a surgeon as they would progress through the learning curve of advanced robotic surgery. Future studies are needed to confirm the optimal case volume for determining the skill level for the performance of rAWR.
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Affiliation(s)
- A Irfan
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - S Cochrun
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - K He
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - L Okorji
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA
| | - Abhishek D Parmar
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building #525, Birmingham, AL, 35294, USA.
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22
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Love MW, Carbonell AM. Robotic transversus abdominis release: A paradigm shift in complex abdominal wall surgery? Cir Esp 2023; 101 Suppl 1:S28-S32. [PMID: 38042589 DOI: 10.1016/j.cireng.2023.01.012] [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: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 12/04/2023]
Abstract
Abdominal wall reconstruction techniques have evolved significantly over the last fifty years and continue to do so at an increasing pace. Beginning with open incisional hernia repair with bilateral rectus myofascial release, multiple techniques to offset tension at the midline by exploring options of layered myofascial release have been described. This article reviews the history, technique, advancements, and future of myofascial release in abdominal wall reconstruction leading from the open Rives-Stoppa repair to the robotic-assisted iteration of the transversus abdominis release.
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Affiliation(s)
- Michael Wesley Love
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, University of South Carolina School of Medicine-Greenville, Greenville, SC, United States
| | - Alfredo M Carbonell
- Division of Minimal Access and Bariatric Surgery, Department of Surgery, Prisma Health-Upstate, University of South Carolina School of Medicine-Greenville, Greenville, SC, United States.
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23
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Collins CE, Renshaw S, Huang LC, Phillips S, Gure TR, Poulose B. Robotic vs. Open Approach for Older Adults Undergoing Retromuscular Ventral Hernia Repair. Ann Surg 2023; 277:697-703. [PMID: 35129505 DOI: 10.1097/sla.0000000000005260] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe 30-day outcomes including post-operative complications, readmissions, and quality of life score changes for older adults undergoing elective ventral hernia repair with retromuscular mesh placement and to compare rates of these outcomes for individuals undergoing robotic versus open approaches. SUMMARY OF BACKGROUND DATA Over one third of patients presenting for elective ventral hernia repair are over the age of 65 and many have complex surgical histories that warrant intricate hernia repairs. Robotic ventral hernia repairs have gained increasing popularity in the US and in some studies have demonstrated decreased rates of postoperative complications, and less pain resulting in shorter hospital stays. However, the robotic approach has several downsides including prolonged operative times as well as the use of pneumo-peritoneum which may be risky in older patients. METHODS We performed a retrospective review of prospectively collected data in a national hernia specific registry (the Abdominal Core Health Quality Collaborative) and identified patients over the age of 65 undergoing either an open or robotic retromuscular ventral hernia repair. After propensity score matching adjusting for demographic, clinical, and hernia related factors, logistic regression was used to compare 30-day complications, readmission, and quality of life (QoL) scores as captured by the HerQLes scale for patients undergoing each approach. RESULTS Of 2128 patients who met inclusion criteria, 1695 (79.7%) underwent open ventral hernia repair while 433 (20.3%) underwent robotic repair. After propensity score matching, there were 350 robotic cases and 759 open cases for analysis. Patients undergoing robotic repairs demonstrated significantly shorter length of stays (1 vs 4 days, P < 0.01) and had equivalent odds of both 30-day post-operative complications (odds ratio [OR] 1.15 95% confidence interval 0.92-1.44) and readmission (OR 1.09 95% confidence interval 0.74-1.6) compared to the open approach. QoL scores were similar between groups at 30 days but were slightly better for robotic patients at 1 year (92 vs 84 P < 0.01). CONCLUSIONS Robotic ventral hernia repair is an option for appropriately selected older patients undergoing retromuscular ventral hernia repair, demonstrating shorter hospital stays and equivalent rates of complications and readmissions in the post-operative period. However, more data is needed regarding QoL outcomes and long-term function, especially as it relates to recurrence rates, between the two approaches.
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Affiliation(s)
- Courtney E Collins
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
| | - Savannah Renshaw
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
| | - Li-Ching Huang
- Department of Surgery Vanderbilt University, Nashville, TN
| | | | - Tanya R Gure
- Department of Internal Medicine, Division of General Internal Medicine & Geriatrics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin Poulose
- Center for Abdominal Core Health, Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center. Columbus, OH
- Department of Internal Medicine, Division of General Internal Medicine & Geriatrics, The Ohio State University Wexner Medical Center, Columbus, OH
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24
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Less postoperative pain and shorter length of stay after robot-assisted retrorectus hernia repair (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for small or medium-sized ventral hernias. Surg Endosc 2023; 37:1053-1059. [PMID: 36109358 DOI: 10.1007/s00464-022-09608-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The optimal repair of ventral hernia remains unknown. We aimed to evaluate the results after robotic-assisted laparoscopic transabdominal repair with retrorectus mesh placement (rRetrorectus) compared with laparoscopic intraperitoneal onlay mesh repair (IPOM) for patients with small- or medium-sized ventral hernia. METHODS This was a retrospective cohort study of consecutive patients undergoing elective rRetrorectus or IPOM repair for small or medium-sized primary ventral or incisional hernias. The primary outcome was the postoperative need for transverse abdominis plane (TAP) block or epidural analgesia, secondary outcomes were length of stay and postoperative complications. All patients were followed for 30 days postoperatively. RESULTS A total of 59 patients were included undergoing rRetrorectus (n = 27) and IPOM (n = 32). Patients in the two groups were comparable in terms of age, sex, comorbidities, smoking status, body mass index (BMI), and type of hernia. The median fascial defect area was slightly larger in the rRetrorectus group (9 cm2 vs. 6.2 cm2, P = 0.031). The duration of surgery was longer for rRetrorectus (median 117.2 min. vs. 84.4, P = 0.003), whereas the postoperative need for TAP block or epidural analgesia was less after rRetrorectus compared with IPOM (3.7% versus 43.7%, P = 0.002). There were no severe complications or reoperations after either procedure. The length of stay was shorter after rRetrorectus (median 0 vs. 1 day, P < 0.001). CONCLUSIONS rRetrorectus was associated with reduced postoperative analgesic requirement and shorter length of stay compared with laparoscopic IPOM. Registration Clinicaltrial.gov: NCT05320055.
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25
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Robotic transversus abdominis release: A paradigm shift in complex abdominal wall surgery? Cir Esp 2023. [DOI: 10.1016/j.ciresp.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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26
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Scrushy MG, Jacobson JC, Pandya SR, Gillory LA. Robotic repair of pediatric hernias: Current techniques and practices. Semin Pediatr Surg 2023; 32:151261. [PMID: 36736163 DOI: 10.1016/j.sempedsurg.2023.151261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of minimally invasive surgical techniques has gained popularity in pediatric surgery due to decreased length of stay, improved post-operative pain and smaller incisions. Laparoscopic assisted robotic surgical procedures are becoming more common in adults as they carry all of the benefits of traditional MIS but also allow for improved dexterity, visualization and surgeon ergonomics. In adults, hernia repairs are one of the most commonly performed robotic cases but adaption to pediatric repairs has been slower. Case reports and small case series have described a number of various types of pediatric hernia repairs including congenital diaphragmatic hernias, paraesophageal hernias and inguinal hernias. These cases have demonstrated that robotic repair of pediatric hernias is safe and feasible with minimal documented post-operative complications or recurrence. Future directions should focus on larger patient volume in order to assess outcomes between traditional laparoscopic and robotic approaches.
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Affiliation(s)
- Marinda G Scrushy
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Jillian C Jacobson
- Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Samir R Pandya
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA
| | - Lauren A Gillory
- Division of Pediatric Surgery, Children's Medical Center, 1935 Medical District Drive, Suite D2000, Dallas, TX, 75235 USA; Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. Dallas, TX 75390 USA.
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Ibrahim MK, Bashar BS, Al-Nabi NRA, Ismail MM. Robot-assisted for medical surgery: A literature review. AIP CONFERENCE PROCEEDINGS 2023. [DOI: 10.1063/5.0119586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Kudsi OY, Kaoukabani G, Bou-Ayash N, Gokcal F. Does the mesh type influence the outcomes and costs of robotic inguinal hernia repair? J Robot Surg 2022; 17:971-978. [DOI: 10.1007/s11701-022-01494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
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Rios-Diaz AJ, Morris MP, Christopher AN, Patel V, Broach RB, Heniford BT, Hsu JY, Fischer JP. National epidemiologic trends (2008-2018) in the United States for the incidence and expenditures associated with incisional hernia in relation to abdominal surgery. Hernia 2022; 26:1355-1368. [PMID: 36006563 DOI: 10.1007/s10029-022-02644-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unknown whether the trend of rising incisional hernia (IH) repair (IHR) incidence and costs until 2011 currently persists. We aimed to evaluate how the IHR procedure incidence, cost and patient risk-profile have changed over the last decade relative to all abdominal surgeries (AS). METHODS Repeated cross-sectional analysis of 38,512,737 patients undergoing inpatient 4AS including IHR within the 2008-2018 National Inpatient Sample. Yearly incidence (procedures/1,000,000 people [PMP]), hospital costs, surgical and patient characteristics were compared between IHR and AS using generalized linear and multinomial regression. RESULTS Between 2008-2018, 3.1% of AS were IHR (1,200,568/38,512,737). There was a steeper decrease in the incidence of AS (356.5 PMP/year) compared to IHR procedures (12.0 PMP/year) which resulted in the IHR burden relative to AS (2008-2018: 12,576.3 to 9,113.4 PMP; trend difference P < 0.01). National costs averaged $47.9 and 1.7 billion/year for AS and IHR, respectively. From 2008-2018, procedure costs increased significantly for AS (68.2%) and IHR (74.6%; trends P < 0.01). Open IHR downtrended (42.2%), whereas laparoscopic (511.1%) and robotic (19,301%) uptrended significantly (trends P < 0.01). For both AS and IHR, the proportion of older (65-85y), Black and Hispanic, publicly-insured, and low-income patients, with higher comorbidity burden, undergoing elective procedures at small- and medium-sized hospitals uptrended significantly (all P < 0.01). CONCLUSION IH persists as a healthcare burden as demonstrated by the increased proportion of IHR relative to all AS, disproportionate presence of high-risk patients that undergo these procedures, and increased costs. Targeted efforts for IH prevention have the potential of decreasing $17 M/year in costs for every 1% reduction.
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Affiliation(s)
- A J Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - M P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - A N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - V Patel
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA
| | - B T Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - J Y Hsu
- Center for Clinical Epidemiology and Biostatistics (CCEB), University of Pennsylvania, Philadelphia, PA, USA
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, USA.
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Outcomes of open transverse abdominis release for ventral hernias: a systematic review, meta-analysis and meta-regression of factors affecting them. Hernia 2022; 27:235-244. [PMID: 35922698 DOI: 10.1007/s10029-022-02657-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary objectives were to evaluate Surgical Site Occurrences (SSO) and Surgical Site Occurrences requiring procedural Intervention (SSOPI) after open transversus abdominis release and to study various factors affecting it. Secondary objectives were to evaluate Surgical Site Infections (SSI), recurrence rates and overall complications after transversus abdominis release (TAR) and the factors responsible for those. METHODS We searched PUBMED, SCOPUS and Cochrane databases with keywords "transversus abdominis release" or "TAR" OR "Surgical Site Occurrences" OR "posterior component separation AND "outcomes" as per PRISMA 2020 and MOOSE guidelines. Full texts and English literature studies were included, studies mentioning outcomes for open transversus abdominis release for ventral hernia were included and studies with robotic transversus abdominis release were excluded. Percentage occurrences of SSO, SSOPI, SSI, recurrence and overall complications after TAR were evaluated. Random effect meta-analysis with restricted maximum likelihood methods was used for meta-analysis. Heterogeneity was analysed using I2 statistics. Publication bias with eager's test and funnel plots. Meta0regression analysis was done to evaluate factors affecting the heterogeneity. JASP 0.16.2 software was used for meta-analysis. RESULTS Twenty-two studies including 5284 patients who underwent TAR for ventral hernia were included in systematic review and meta-analysis. Overall pooled SSO, SSOPI, Overall Complications, SSI and recurrence rates were 21.72% [95% C.I 17.18-26.27%], 9.82% [95% C.I 7.64 -12%], 33.34% [95% C.I. 27.43-39.26%], 9.13% [95% C.I. 6.41-11.84] and 1.6% [0.78-2.44], respectively. Heterogeneity was significant in all the analysis. Age (p < 0.001), sex (p < 0.001), BMI (p < 0.001),presence of comorbidities (p < 0.001), prior recurrence, defect size (p < 0.001) and current or past history of tobacco exposure were associated with SSO in multivariate meta-regression analysis. Defect size (p = 0.04) was associated with SSOPI. Age (p = 0.011), BMI (p = 0.013), comorbidities (p < 0.01), tobacco exposure (p = 0.018), prior recurrence (p < 0.01) and sex (p < 0.01) were associated with overall complications. CONCLUSION Open transversus abdominis release is associated with high rates of SSO, SSOPI, SSI and overall complications but recurrence rates are low. Various preoperative factors mentioned may be responsible for heterogeneity across studies.
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Wegdam JA, de Jong DLC, de Vries Reilingh TS, Schipper EE, Bouvy ND, Nienhuijs SW. Assessing Textbook Outcome After Implementation of Transversus Abdominis Release in a Regional Hospital. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10517. [PMID: 38314160 PMCID: PMC10831686 DOI: 10.3389/jaws.2022.10517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/07/2022] [Indexed: 02/06/2024]
Abstract
Background: The posterior component separation technique with transversus abdominis release (TAR) was introduced in 2012 as an alternative to the classic anterior component separation technique (Ramirez). This study describes outcome and learning curve of TAR, five years after implementation of this new technique in a regional hospital in the Netherlands. Methods: A standardized work up protocol, based on the Plan-Do-Check-Act cycle, was used to implement the TAR. The TAR technique as described by Novitsky was performed. After each 20 procedures, outcome parameters were evaluated and new quality measurements implemented. Primary outcome measure was Textbook Outcome, the rate of patients with an uneventful clinical postoperative course after TAR. Textbook Outcome is defined by a maximum of 7 days hospitalization without any complication (wound or systemic), reoperation or readmittance, within the first 90 postoperative days, and without a recurrence during follow up. The number of patients with a Textbook Outcome compared to the total number of consecutively performed TARs is depicted as the institutional learning curve. Secondary outcome measures were the details and incidences of the surgical site and systemic complications within 90 days, as well as long-term recurrences. Results: From 2016, sixty-nine consecutive patients underwent a TAR. Textbook Outcome was 35% and the institutional learning curve did not flatten after 69 procedures. Systemic complications occurred in 48%, wound complications in 41%, and recurrences in 4%. Separate analyses of three successive cohorts of each 20 TARs demonstrated that both Textbook Outcome (10%, 30% and 55%, respectively) and the rate of surgical site events (45%, 15%, and 10%) significantly (p < 0.05) improved with more experience. Conclusion: Implementation of the open transversus abdominis release demonstrated that outcome was positively correlated to an increasing number of TARs performed. TAR has a long learning curve, only partially determined by the technical aspects of the operation. Implementation of the TAR requires a solid plan. Building, and maintaining, an adequate setting for patients with complex ventral hernias is the real challenge and driving force to improve outcome.
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Affiliation(s)
| | | | | | | | - Nicole D. Bouvy
- Maastricht University Medical Centre, Maastricht, Netherlands
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Käkelä P, Mustonen K, Rantanen T, Paajanen H. Robotic versus hybrid assisted ventral hernia repair: a prospective one-year comparative study of clinical outcomes. Acta Chir Belg 2022:1-7. [PMID: 35451935 DOI: 10.1080/00015458.2022.2069656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laparoscopic ventral hernia repair (LVHR) may be associated with chronic pain, seroma formation, bulging and failure to restore abdominal wall function. These outcomes are risk factors for hernia recurrence and poor quality of life (QoL). Our study evaluates whether robotic-assisted ventral hernia repair (rVHR) diminishes these complications compared to LVHR with primary closure of the defect (hybrid). METHODS Thirty-eight consecutive patients undergoing incisional ventral hernia operation with fascial defect size from 3 to 6 cm were recruited between November 2019 and October 2020. Nineteen patients underwent rVHR and nineteen underwent hybrid operation. The main outcome measure was postoperative pain, evaluated with a visual analogue scale (VAS: 0-10) at 1-month and at 1-year. Hernia recurrence was evaluated with ultrasound examination and QoL using the generic SF-36 short form questionnaire. RESULTS At the 1-month control visit, VAS scores were significantly lower in the rVHR group; 2.5 in the hybrid group and 0.3 in the rVHR group (p < 0.001). At the 1-year control, the difference in VAS scores was still significant, 2.8 vs 0.1 (p = 0.023). There was one hernia recurrence in the hybrid group (p = 0.331). QoL did not differ significantly between the study groups when compared to preoperative physical status at 1-year follow-up (p = 0.121). However, emotional status (p = 0.049) and social functioning (p = 0.039) improved significantly in the rVHR group. CONCLUSIONS Robotic-assisted ventral hernia repair (rVHR) was less painful compared to hybrid repair at 1-month and at 1-year follow-up. In addition, improvement in social functioning status was reported with rVHR. TRIAL REGISTRATION ID 5200658.
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Affiliation(s)
- Pirjo Käkelä
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Mustonen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Tuomo Rantanen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Hannu Paajanen
- Department of Surgery, University of Eastern Finland and Mikkeli Central Hospital, Mikkeli, Finland
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Bloemendaal ALA. Case Report: Intraoperative Fascial Traction in Robotic Abdominal Wall Surgery; An Early Experience. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10356. [PMID: 38314155 PMCID: PMC10831714 DOI: 10.3389/jaws.2022.10356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2024]
Abstract
Intraoperative fascial traction (IFT) may obviate the use of a posterior component separation/transversus abdominis release (TAR). Robotic abdominal wall surgery leads to a reduction of morbidity in TAR compared to open surgery. The combination of minimally invasive (robotic) abdominal wall surgery with IFT may lead to a further reduction of surgical morbidity.
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Kudsi OY, Gokcal F, Bou-Ayash N, Watters E, Pereira X, Lima DL, Malcher F. A comparison of outcomes between class-II and class-III obese patients undergoing robotic ventral hernia repair: a multicenter study. Hernia 2022; 26:1531-1539. [PMID: 35305193 DOI: 10.1007/s10029-022-02594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Morbid obesity has been considered a contraindication to ventral hernia repair (VHR) in the past. However, the relationship between a greater body mass index (BMI) and adverse outcomes has yet to be established in the minimally invasive sphere, particularly with robotics, which may offer an effective surgical option in these high-risk patients. We sought to investigate this relationship by comparing the outcomes of class-II (BMI: 35-39.9 kg/m2) and class-III (BMI: ≥ 40 kg/m2) obese patients after robotic VHR (RVHR). METHODS Data were analyzed from two centers and six surgeons who performed RVHR between 2013 and 2020. Patients with a BMI > 35 kg/m2 were included in the study. A 1:1 propensity score match (PSM) analysis was conducted to obtain balanced groups and univariate analyses were conducted to compare the two groups across preoperative, intraoperative, and post-operative timeframes. Postoperative complications and morbidity were reported according to the Clavien-Dindo Classification and comprehensive complication index (CCI®) systems. RESULTS From an initial cohort of 815 patients, 228 patients with a mean BMI of 39.7 kg/m2 were included in the study. PSM analysis stratified these into 69 patients for each of the class-II and class-III groups. When comparing matched groups, there were no differences in any of the variables across all timeframes, except for a higher rate of Polytetrafluoroethylene (PTFE)-based mesh use in the class-III group (39.1% vs 17.4%, p = 0.008). The estimated recurrence-free time was 76.4 months (95% CI = 72.5-80.4) for the class-II group and 80.4 months (95% CI = 78-82.8) for the class-III group. CONCLUSION This multicenter study showed no difference in outcomes after RVHR between matched class-II and class-III obese patients.
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Affiliation(s)
- O Y Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.
| | - F Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - N Bou-Ayash
- Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - E Watters
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - X Pereira
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - D L Lima
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - F Malcher
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
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35
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Bracale U, Stabilini C, Imperatore N, Peltrini R. Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Author's reply. Hernia 2022; 26:1213-1214. [PMID: 35254554 DOI: 10.1007/s10029-022-02590-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Affiliation(s)
- U Bracale
- Department of General and Specialistic Surgeries, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
| | - C Stabilini
- Department of Surgical Sciences, University of Genoa, Policlinico San Martino IRCCS, Genova, Italy
| | - N Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Peltrini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Dewulf M, De Bacquer D, Muysoms F. Comment to: transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 2022; 26:1211-1212. [PMID: 35044546 DOI: 10.1007/s10029-022-02568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
Affiliation(s)
- M Dewulf
- Department of Surgery, Maastricht UMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - D De Bacquer
- Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - F Muysoms
- Maria Middelares Hospital, Ghent, Belgium
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Cuccurullo D, Guerriero L, Mazzoni G, Sagnelli C, Tartaglia E. Robotic transabdominal retromuscular rectus diastasis (r-TARRD) repair: a new approach. Hernia 2022; 26:1501-1509. [PMID: 34982294 DOI: 10.1007/s10029-021-02547-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of this study is to present our innovative robotic approach for the treatment of rectus diastasis with concurrent primary or incisional ventral hernias. METHODS We performed 45 r-TARRD repairs for symptomatic rectus diastasis with concomitant associated ventral/incisional umbilical and/or epigastric hernias between January 2019 and January 2020. Data on patient demographics, type of hernia, operative time, complications, recurrence rate, and hospital stay were retrospectively analyzed. Follow-up was scheduled at 1, 6 months, and 1 year after surgery. RESULTS 45 patients (13 M, 32 F) underwent r-TARRD repair. Mean age was 54.8 years (range 31-68) and mean BMI was 26.74 kg/m2 (range 21.1-31). Mean ASA was 2.2 (range 1-3). In all patients we used a polypropylene mesh 25 × 15 cm, properly shaped. Mean operative time was 192 min (range 115-260). Mean hospital stay 4.2 days (range 2-7). No conversion to laparoscopy or open surgery and no major complications occurred. At 1-month follow-up one mesh infection (2.22%) was observed and it was treated conservatively. Four recurrences (8.88%) were reported at 1-year follow-up. CONCLUSIONS Robot-assisted TARRD repair is conceived as a novel alternative minimally invasive procedure for RD with concurrent midline defects ensuring a primary fascial defect closure and mesh implantation in a sublay position with a wide overlap. It is important to better evaluate the suture that should be used to perform the repair, and multicenter studies with standardization of patient's demographics, RD characteristics, and long-term follow-up outcomes are mandatory to assess the effectiveness and durability of r-TARDD repair.
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Affiliation(s)
- D Cuccurullo
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - L Guerriero
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - G Mazzoni
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - C Sagnelli
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy
| | - E Tartaglia
- Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera dei Colli "Monaldi Hospital", 80131, Naples, Italy.
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Kudsi OY, Gokcal F, Bou-Ayash N, Crawford AS, Chang K, Chudner A, La Grange S. Robotic Ventral Hernia Repair: Lessons Learned From a 7-year Experience. Ann Surg 2022; 275:9-16. [PMID: 34380969 DOI: 10.1097/sla.0000000000004964] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the outcomes of RVHR with varying prosthetic reinforcement techniques. SUMMARY OF BACKGROUND DATA As a recent addition to minimally invasive hernia repair, more data is needed to establish the long-term benefits of RVHR and to identify potential predictors of adverse outcomes. METHODS Patients who underwent RVHR over a 7-year period were evaluated. Robotic intraperitoneal onlay mesh (rIPOM), transabdominal preperitoneal (rTAPP), Rives-Stoppa (rRS), and transversus abdominis release (rTAR) techniques were compared. The main outcomes were 90-day FFC, and 5-year FFR, depicted through Kaplan-Meier curves stratified by repair type and date. RESULTS A total of 644 RVHRs were analyzed; 197 rIPOM, 156 rTAPP, 153 rRS, and 138 rTAR. There was a gradual transition from intraperitoneal to extraperitoneal mesh placement across the study period. Although rTAPP had the highest 90-day FFC (89.5%) it also had the lowest 5-year FFR (93.3%). Conversely, although rTAR demonstrated the lowest FFC (71%), it had the highest FFR (100%). Coronary artery disease, lysis of adhesions, incisional hernia, and skin-to-skin time (10 minutes. increment) were significant predictors of 90-day complications. Incisional hernia was the sole predictor of 5-year recurrence. CONCLUSIONS This study provides an in-depth perspective of the largest series of RVHR. Based on this experience, rTAPP is no longer recommended due to its limited applicability and high recurrence rate. Both rIPOM and rRS offer encouraging short- and long-term outcomes, while rTAR is associated with the highest perioperative morbidity. Longer follow-up is needed to assess rTAR durability, despite a promising recurrence profile.
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Affiliation(s)
- Omar Yusef Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | - Fahri Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | - Naseem Bou-Ayash
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | | | - Karen Chang
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | - Alexandra Chudner
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
| | - Sara La Grange
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, Massachusetts
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Dewulf M, Hiekkaranta JM, Mäkäräinen E, Saarnio J, Vierstraete M, Ohtonen P, Muysoms F, Rautio T. OUP accepted manuscript. BJS Open 2022; 6:6617230. [PMID: 35748378 PMCID: PMC9227725 DOI: 10.1093/bjsopen/zrac057] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maxime Dewulf
- Correspondence to: Maxime Dewulf, Department of Surgery, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands (e-mail: )
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40
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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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41
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Baier KF, Rosen MJ. Controversies in Abdominal Wall Reconstruction. Surg Clin North Am 2021; 101:1007-1022. [PMID: 34774264 DOI: 10.1016/j.suc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article discuses current controversies in abdominal wall reconstruction, including the standardization of outcome reporting, mesh selection, the utility of robotic surgery in ventral hernia repair, and role for prophylactic stoma mesh at the time of permanent end colostomy formation. The current state of the literature pertaining to these topics is reviewed in detail.
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Affiliation(s)
- Kevin F Baier
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Building A-100, Cleveland, OH 44195, USA
| | - Michael J Rosen
- Center for Abdominal Core Health, Cleveland Clinic Foundation, 9500 Euclid Avenue, Building A-100, Cleveland, OH 44195, USA.
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42
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Muysoms F, Nachtergaele F, Pletinckx P, Dewulf M. ROBotic Utility for Surgical Treatment of hernias (ROBUST hernia project). Cir Esp 2021; 99:629-634. [PMID: 34749923 DOI: 10.1016/j.cireng.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/19/2022]
Abstract
We describe the evolution in hernia repair approaches in our practice during the first 3 years of adopting robotic assisted laparoscopic surgery. For inguinal hernia repair, we began using the robotic platform for complex hernias, and the use of open repair decreased from 17% to 6%. For primary ventral hernias, open procedures decreased from 59% to 10% and for incisional ventral hernias, from 48% to 11%. Moreover, a large shift in mesh position for ventral hernias was seen, with an increase of the retromuscular position from 20% to 82% and a decrease of intraperitoneal mesh position from 48% to 10%. The robotic platform seems to hold a significant potential for complex inguinal hernias, in addition to ventral and incisional hernias which require component separation. A shorter hospital stay and less postoperative complications might make the adoption of the robotic platform for abdominal wall surgery a valuable proposition.
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Affiliation(s)
- Filip Muysoms
- Department of Surgery, Maria Middelares Ghent, Belgium.
| | | | | | - Maxime Dewulf
- Department of Surgery, Maria Middelares Ghent, Belgium; Department of Hepatobiliary Surgery, Maastricht UMC+, The Netherlands
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43
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Ye L, Childers CP, de Virgilio M, Shenoy R, Mederos MA, Mak SS, Begashaw MM, Booth MS, Shekelle PG, Wilson M, Gunnar W, Girgis MD, Maggard-Gibbons M. Clinical outcomes and cost of robotic ventral hernia repair: systematic review. BJS Open 2021; 5:6429826. [PMID: 34791049 PMCID: PMC8599882 DOI: 10.1093/bjsopen/zrab098] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. METHODS This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to 'robot-assisted', 'cost effectiveness', and 'ventral hernia' or 'incisional hernia' from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. RESULTS Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. CONCLUSION Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.
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Affiliation(s)
- Linda Ye
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher P Childers
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michael de Virgilio
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rivfka Shenoy
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA.,National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Michael A Mederos
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Selene S Mak
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Meron M Begashaw
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Paul G Shekelle
- Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
| | - Mark Wilson
- US Department of Veterans Affairs, Washington, DC, USA.,Department of Surgery, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - William Gunnar
- Veterans Health Administration, National Center for Patient Safety, Ann Arbor, Michigan, USA.,University of Michigan, Ann Arbor, Michigan, USA
| | - Mark D Girgis
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Olive View-UCLA Medical Center, Sylmar, California, USA
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44
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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 : Part III: Robotic incisional hernia repair with transversus abdominis release (r-TAR). Video report and results of a cohort study]. Chirurg 2021; 92:936-947. [PMID: 34406440 PMCID: PMC8463520 DOI: 10.1007/s00104-021-01480-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
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 (aKS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pKS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pKS. 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
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz.
| | - 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, Spanien
| | - Johannes Baur
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Michaela Ramser
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Sladjana Maksimovic
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Nicola Keller
- Klinik für Allgemein‑, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Im Engel 1, 5404, Baden, Schweiz
| | - Jörg Dörfer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Lukas Eisner
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Armin Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
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Bracale U, Corcione F, Neola D, Castiglioni S, Cavallaro G, Stabilini C, Botteri E, Sodo M, Imperatore N, Peltrini R. Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 2021; 25:1471-1480. [PMID: 34491460 PMCID: PMC8613152 DOI: 10.1007/s10029-021-02487-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/10/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To compare early postoperative outcomes after transversus abdominis release (TAR) for ventral hernia repair with open (oTAR) and robotic (rTAR) approach. METHODS A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science databases was conducted to identify comparative studies until October 2020. A meta-analysis of postoperative short-term outcomes was performed including complications rate, operative time, length of stay, surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring intervention (SSOPI), systemic complications, readmission, and reoperation rates as measure outcomes. RESULTS Six retrospective studies were included in the analysis with a total of 831 patients who underwent rTAR (n = 237) and oTAR (n = 594). Robotic TAR was associated with lower risk of complications rate (9.3 vs 20.7%, OR 0.358, 95% CI 0.218-0.589, p < 0.001), lower risk of developing SSO (5.3 vs 11.5%, OR 0.669, 95% CI 0.307-1.458, p = 0.02), lower risk of developing systemic complications (6.3 vs 26.5%, OR 0.208, 95% CI 0.100-0.433, p < 0.001), shorter hospital stay (SMD - 4.409, 95% CI - 6.000 to - 2.818, p < 0.001) but longer operative time (SMD 53.115, 95% CI 30.236-75.993, p < 0.01) compared with oTAR. There was no statistically significant difference in terms of SSI, SSOPI, readmission, and reoperation rates. CONCLUSION Robotic TAR improves recovery by adding the benefits of minimally invasive procedures when compared to open surgery. Although postoperative complications appear to decrease with a robotic approach, further studies are needed to support the real long-term and cost-effective advantages.
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Affiliation(s)
- U Bracale
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy
| | - F Corcione
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy.,Department of Public Health, University of Naples Federico II, Naples, Italy
| | - D Neola
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy
| | - S Castiglioni
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy.,Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio Chieti-Pescara, Pescara, Italy
| | - G Cavallaro
- Department of Surgery "P. Valdoni", University of Rome "La Sapienza", Rome, Italy
| | - C Stabilini
- Department of Surgical Sciences, University of Genoa, Policlinico San Martino IRCCS, Genoa, Italy
| | - E Botteri
- General Surgery, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - M Sodo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - N Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - R Peltrini
- Department of General and Specialistic Surgeries, Federico II University Hospital, Naples, Italy. .,Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. .,Department of Public Health, School of Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
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46
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Kudsi OY, Gokcal F, Bou-Ayash N, Crawford AS. Learning curve of robotic transversus abdominis release in ventral hernia repair: a cumulative sum (CUSUM) analysis. Surg Endosc 2021; 36:3480-3488. [PMID: 34494150 DOI: 10.1007/s00464-021-08669-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite heightened interest in robotic transversus abdominis release (rTAR), concerns over its steep learning curve (LC) and associated challenges may limit its adoption. This study defines the operative time and morbidity-based LC of a single surgeon's experience with rTAR. METHODS A retrospective analysis of patients undergoing rTAR over an 8-year period was conducted. Consecutive ventral and incisional hernia repairs were stratified into four sub-categories based on bilaterality and complexity, with complex hernias being defined as those > 10 cm. Cumulative sum analyses (CUSUM) were used to evaluate skin-to-skin time and morbidity LCs. RESULTS This study included a total of 156 rTARs with a mean skin-to-skin time of 222.8 min. Mean skin-to-skin times (min) for sub-categories were as follows: unilateral non-complex (137.6), bilateral non-complex (206.8), unilateral complex (241.9), and bilateral complex (298.6). The CUSUM-LC was obtained by summing the differences between each procedure's operative time and its sub-category mean, revealing a quadratic best-fit line maximum at case 49 and a transition point between early and late phases at case 75. Although skin-to-skin times between early and late phases did not differ significantly (235.3 vs 211.2, respectively; p = 0.12), a significant difference was found in console times. Overall postoperative complications also decreased significantly from early to late phases (41.3% vs 25.9%; p = 0.041). Postoperative complications were predicted by a history of wound infection (c = 0.61). CONCLUSIONS This study reveals that the rTAR LC was overcome between 49 and 75 cases, after which, console time and postoperative complications decreased significantly.
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Affiliation(s)
- Omar Yusef Kudsi
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA.
| | - Fahri Gokcal
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
| | - Naseem Bou-Ayash
- Department of Surgery, Good Samaritan Medical Center, Tufts University School of Medicine, One Pearl Street, Brockton, MA, 02301, USA
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47
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Bellorin O, Senturk JC, Cruz MV, Alt R, Dakin G, Afaneh C. A cost analysis of two- versus three-instrument robotic-assisted inguinal hernia repair with mesh: time is money. J Robot Surg 2021; 16:377-382. [PMID: 33997917 DOI: 10.1007/s11701-021-01250-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
Equipment expenses and operating times can lead to higher costs with robotic surgery. We compared the cost-effectiveness of 2- vs. 3-instrument (2i vs. 3i) approach to robotic transabdominal preperitoneal inguinal hernia repair. We conducted a retrospective study of 172 patients, with 86 patients in each group. Procedure cost, operative time, morbidity, length of stay, readmission rate, and hernia recurrence at 90 days were compared. Statistical significance was assigned to p < 0.05. No significant differences in preoperative variables nor in postoperative outcomes were identified. Mean operative time was 6 min longer in the 2i group and this approach cost $300 less. The 2i approach was cost-effective for operating room (OR) costs of less than $50 per minute. Surgeon efficiency and OR dollar-per-minute value influence the potential for cost savings with fewer instruments in robotic herniorrhaphy. There is no difference in outcomes when fewer instruments are used.
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Affiliation(s)
- Omar Bellorin
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - James C Senturk
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Mariana Vigiola Cruz
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Rachel Alt
- Department of Surgery, Valley Medical Group, Ridgewood, NJ, 07450, USA
| | - Gregory Dakin
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Cheguevara Afaneh
- Department of Surgery, New York Presbyterian Hospital- Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
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Pini R, Di Giuseppe M, Toti JMA, Mongelli F, Marcantonio M, Spampatti S, La Regina D. Robot-assisted Treatment of Epigastric Hernias With a Suprapubic Approach. Surg Laparosc Endosc Percutan Tech 2021; 31:584-587. [PMID: 33900226 DOI: 10.1097/sle.0000000000000941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience of epigastric hernia treatment with trocar insertion in the suprapubic region. MATERIALS AND METHODS On a prospectively collected dataset on robot-assisted surgery, patients treated for epigastric hernias with suprapubic approach were identified. Demographic and clinical data were collected and analyzed. RESULTS Twelve patients were selected. Median age was 58.5 years [interquartile range (IQR): 47.8 to 67.3 y]; 4 patients were male (33.3%) and the median body mass index was 23.9 kg/m2 (IQR: 22.3 to 26.2 kg/m2). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR: 13.75 to 31.0 mm); median larger mesh diameter was 13.5 cm (IQR: 9.5 to 15.0 cm); and median operative time was 136.5 minutes (IQR: 120.0 to 186.5 min). No intraoperative complication or conversion to open surgery occurred. Postoperatively, 2 patients presented a seroma and median length of hospital stay was 2.0 days (IQR: 1.75 to 3 d). No case of hernia recurrence was recorded at a mean follow-up of 11.2 months (range: 4 to 29 mo). CONCLUSIONS In the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one to have a better field overview, especially in subxiphoid hernias. Further studies are needed to assess the benefits and limitations of such technique.
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Affiliation(s)
- Ramon Pini
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Matteo Di Giuseppe
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | - Johannes M A Toti
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Maria Marcantonio
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
| | | | - Davide La Regina
- Department of Surgery, Regional Hospital of Bellinzona e Valli, Bellinzona
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[Current robotic ventral hernia surgery exemplified by 50 consecutive patients]. Chirurg 2021; 93:82-88. [PMID: 33876252 DOI: 10.1007/s00104-021-01407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In recent years there has been a rise in robotic techniques and approaches regarding hernia repair with extraperitoneal mesh placement. METHODS A retrospective analysis of the first 50 patients who underwent robotic ventral hernia repair between May 2019 and November 2020 at the department of general surgery of the Kempten Clinic was performed. RESULTS This case series consisted of 36 incisional hernias, 12 primary hernias (8 umbilical and 3 epigastric hernias in combination with a diastasis recti abdominis as well as 1 Spigelian hernia) and 2 parastomal hernias. A complete closure of the hernia was achieved in all cases. Extraperitoneal mesh placement in the retromuscular or preperitoneal space was achieved in 98 % of the ventral procedures. We used an extraperitoneal approach with retromuscular mesh implantation (r-eTEP= robotic enhanced view total extraperitoneal plasty) in 22 cases, 3 of those along with a transversus abdominis release (r-eTAR= robotic extraperitoneal transversus abdominis release) and 26 operations were carried out transperitoneally. These included 11 preperitoneal (r-vTAPP= robotic ventral TAPP), 7 retrorectus (TARUP= robotic transabdominal retromuscular umbilical prosthetic hernia repair) and 1 intraperitoneal onlay mesh placements (r-IPOM= robotic intraperitoneal onlay mesh) as well as 7 transperitoneal transversus abdominis releases with retromuscular mesh placement. The 2 parastomal hernias were treated with an intraperitoneal 3D funnel mesh. After the initial treatment of smaller hernias the indications could be rapidly extended to complex hernias in 38 % of this case series. One conversion to an open operation was necessary due to technical problems in closing the posterior rectus sheath. The complication rate was 12 % and the reintervention rate 4 %. CONCLUSION Robotic surgery of ventral hernia is safe and effective. Even complex hernias can be treated minimally invasively with closure of the hernia defect and extraperitoneal mesh placement.
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Nguyen B, David B, Shiozaki T, Gosch K, Sorensen GB. Comparisons of abdominal wall reconstruction for ventral hernia repairs, open versus robotic. Sci Rep 2021; 11:8086. [PMID: 33850165 PMCID: PMC8044101 DOI: 10.1038/s41598-021-86093-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/19/2021] [Indexed: 11/09/2022] Open
Abstract
The surgical complexities of our current population have pushed the technological limits of healthcare, urging for minimally invasive approaches. For ventral hernias, in particular, robotic assisted laparoscopic repairs have been met with conflict. Cost and longer operative times are among the arguments against robotic surgery, although thorough evaluation of patient outcomes could potentially advocate for use of this tool. We attempted to approach this by retrospectively reviewing our own data. We reviewed charts between September 2016 and February 2017 of patients receiving complex hernia repairs, either a standard open repair (SOR) or robotic-assisted repair (RAR). Data collected included preoperative, perioperative, and postoperative care. Of the 43 patients reviewed, 16 were SOR, versus 27 RAR. Patients were comparable in age, gender, BMI, diabetes as a comorbidity; average hernia defect size was similar between the two groups. Although operative times were longer in the RAR group, estimated blood loss (EBL) was less. Hospital stay was also shorter in the RAR group, at 3.0 ± 1.9 days versus 9.6 ± 8.4 days for the OAR group. Of those requiring critical care management, only one patient had a robotic assisted repair, versus half of the patients who received an open repair. Of the patients who presented to the emergency department within 30 days of surgery, each group had four patients, and two from the OAR group required admission. Our data is consistent with other literature supporting shorter lengths of stays. Although the robotic approach did required a longer operative time, the resulting improved patient outcomes support this technique for complex ventral hernia repairs.
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Affiliation(s)
- Barbara Nguyen
- Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
- St. Luke's Hospital on the Plaza, Kansas City, MO, USA
| | - Bryan David
- Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
- St. Luke's Hospital on the Plaza, Kansas City, MO, USA
| | - Teisha Shiozaki
- Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
- St. Luke's Hospital on the Plaza, Kansas City, MO, USA
| | - Kensey Gosch
- Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA
- St. Luke's Hospital on the Plaza, Kansas City, MO, USA
| | - G Brent Sorensen
- Department of General Surgery, University of Missouri-Kansas City, Kansas City, MO, USA.
- St. Luke's Hospital on the Plaza, Kansas City, MO, USA.
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