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Furukawa S, Wakiyama K, Okamura K, Noshiro H. Usefulness of laparoscopic inguinal hernia repair using the Endoscope Manipulator Robot (EMARO). Hernia 2024; 28:1461-1465. [PMID: 38907879 DOI: 10.1007/s10029-024-03090-0] [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: 04/02/2024] [Accepted: 06/09/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO). METHODS This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups. RESULTS Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77-87) and 70 min (range, 60-94), respectively, and the median blood loss was 5 mL (range, 1-5) and 2 mL (range, 1-5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5-12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042). CONCLUSION Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed.
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Affiliation(s)
- Shunsuke Furukawa
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan
| | - Kota Wakiyama
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan.
| | - Keiji Okamura
- Department of Surgery, Shiroishi Kyouritsu Hospital, Kishima, Japan
- Department of Surgery, Yamaguchi University Faculty of Medicine, Saga, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
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Hatewar A, Mahakalkar C, Kshirsagar S, Ram Sohan P, Dixit S, Bikkumalla S. From Meshes to Minimally Invasive Techniques: A Comprehensive Review of Modern Hernia Repair Approaches. Cureus 2024; 16:e66206. [PMID: 39233930 PMCID: PMC11374351 DOI: 10.7759/cureus.66206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Hernias are a common medical condition characterized by the protrusion of organs or tissues through weakened muscle walls, affecting millions worldwide annually. Historically, from being treated with open surgeries using tension-free mesh repairs, the landscape of hernia repair has evolved significantly. This evolution has been marked by the advent and refinement of minimally invasive techniques, including laparoscopic and robotic-assisted approaches, which offer reduced postoperative pain, shorter recovery times, and improved patient outcomes compared to traditional methods. This comprehensive review aims to elucidate the evolution of hernia repair techniques, emphasizing the transition from conventional mesh repairs to advanced minimally invasive methodologies. By examining the historical progression and current state of hernia surgery, this review thoroughly analyzes the advancements in surgical techniques, materials, and technologies. Furthermore, it explores emerging trends such as biological meshes, ultrasound-guided procedures, and 3D printing applications in hernia repair. The clinical significance of these advancements lies in their potential to enhance the patient's quality of life, minimize complications, and optimize healthcare resource utilization. Insights gained from this review will inform clinicians and researchers about the efficacy, safety, and comparative effectiveness of various hernia repair approaches, guiding future directions in hernia management and fostering innovation in surgical practice.
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Affiliation(s)
- Akansha Hatewar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chanrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani Kshirsagar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Poosarla Ram Sohan
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sparsh Dixit
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruthi Bikkumalla
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Aiolfi A, Bona D, Calì M, Manara M, Bonitta G, Cavalli M, Bruni PG, Carmignani L, Danelli P, Bonavina L, Köckerling F, Campanelli G. Is previous radical prostatectomy a contraindication to minimally invasive inguinal hernia repair? A contemporary meta-analysis. Hernia 2024:10.1007/s10029-024-03098-6. [PMID: 38990229 DOI: 10.1007/s10029-024-03098-6] [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: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Traditionally, radical prostatectomy (RP) has been considered a contraindication to minimally invasive inguinal hernia repair. Purpose of this systematic review was to examine the current evidence and outcomes of minimally invasive inguinal hernia repair after RP. MATERIALS AND METHODS Web of Science, PubMed, and EMBASE data sets were consulted. Laparoscopic transabdominal preperitoneal repair (TAPP), robotic TAPP (r-TAPP), and totally extraperitoneal (TEP) repair were included. RESULTS Overall, 4655 patients (16 studies) undergoing TAPP, r-TAPP, and TEP inguinal hernia repair after RP were included. The age of the patients ranged from 35 to 85 years. Open (49.1%), laparoscopic (7.4%), and robotic (43.5%) RP were described. Primary unilateral hernia repair was detailed in 96.3% of patients while 2.8% of patients were operated for recurrence. The pooled prevalence of intraoperative complication was 0.7% (95% CI 0.2-3.4%). Bladder injury and epigastric vessels bleeding were reported. The pooled prevalence of conversion to open was 0.8% (95% CI 0.3-1.7%). The estimated pooled prevalence of seroma, hematoma, and surgical site infection was 3.2% (95% CI 1.9-5.9%), 1.7% (95% CI 0.9-3.1%), and 0.3% (95% CI = 0.1-0.9%), respectively. The median follow-up was 18 months (range 8-48). The pooled prevalence of hernia recurrence and chronic pain were 1.1% (95% CI 0.1-3.1%) and 1.9% (95% CI 0.9-4.1%), respectively. CONCLUSIONS Minimally invasive inguinal hernia repair seems feasible, safe, and effective for the treatment of inguinal hernia after RP. Prostatectomy should not be necessarily considered a contraindication to minimally invasive inguinal hernia repair.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy.
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Matteo Calì
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Michele Manara
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Marta Cavalli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Piero Giovanni Bruni
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Luca Carmignani
- Division of Urology, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piergiorgio Danelli
- Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L. Sacco University Hospital, 20157, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - Giampiero Campanelli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
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Li X, Li YJ, Dong H, Wang DC, Wei J. Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia. PLoS One 2024; 19:e0298989. [PMID: 38408054 PMCID: PMC10896538 DOI: 10.1371/journal.pone.0298989] [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: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Inguinal hernia is a common global disease. This study aims to investigate the effectiveness and safety of robot-assisted transabdominal preperitoneal repair (RTAPP) and laparoscopic transabdominal preperitoneal repair (LTAPP) for inguinal hernia. METHODS We conducted a thorough search in Cochrane Library, Embase, and PubMed for relevant clinical studies. After applying inclusion and exclusion criteria, the quality of selected studies was assessed using the Jadad scale for randomized controlled studies and the Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of ten studies were included, comprising two randomized controlled studies and eight non-randomized controlled studies. Meta-analysis results revealed no statistically significant differences between the RTAPP group and the LTAPP group regarding hospital stay [MD = 0.21 days, 95% CI (-0.09, 0.51), P = 0.17], incidence of seroma [OR = 0.85, 95% CI(0.45, 1.59), P = 0.61], overall complication rate [OR = 1.22, 95% CI(0.68, 2.18), P = 0.51], readmission rate [OR = 1.31, 95% CI(0.23, 7.47), P = 0.76], and recurrence rate [OR = 0.82, 95% CI(0.22, 3.07), P = 0.77]. However, the RTAPP group had longer operation time compared to the LTAPP group [MD = 14.02 minutes, 95% CI (6.65, 21.39), P = 0.0002], and the cost of the RTAPP procedure was higher than that of the LTAPP procedure [MD = $4.17 thousand, 95% CI (2.59, 5.76), P<0.00001]. CONCLUSION RTAPP for inguinal hernia is a safe and feasible approach, however, it is associated with increased operation time and treatment costs.
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Affiliation(s)
- Xi Li
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Yue-Juan Li
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Hui Dong
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Jian Wei
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
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Anoldo P, Manigrasso M, D’Amore A, Musella M, De Palma GD, Milone M. Abdominal Wall Hernias-State of the Art of Laparoscopic versus Robotic Surgery. J Pers Med 2024; 14:100. [PMID: 38248801 PMCID: PMC10817490 DOI: 10.3390/jpm14010100] [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: 12/21/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Abdominal wall hernia repair, a common surgical procedure, includes various techniques to minimize postoperative complications and enhance outcomes. This review focuses on the comparison between laparoscopic and robotic approaches in treating inguinal and ventral hernias, presenting the ongoing situation of this topic. A systematic search identified relevant studies comparing laparoscopic and robotic approaches for inguinal and ventral hernias. Randomized control trials, retrospective, and prospective studies published after 1 January 2000, were included. Search terms such as hernia, inguinal, ventral, laparoscopy, robotic, and surgery were used. A total of 23 articles were included for analysis. Results indicated similar short-term outcomes for robotic and laparoscopic techniques in inguinal hernia repair, with robotic groups experiencing less postoperative pain. However, longer operative times and higher costs were associated with robotic repair. Robotic ventral hernia repair demonstrated potential benefits, including shorter hospital stay, lower recurrence and lower reoperation rates. While robotic surgery offers advantages such as shorter hospital stays, faster recovery, and less postoperative pain, challenges including costs and training requirements need consideration. The choice between laparoscopic and robotic approaches for abdominal wall hernias should be tailored based on individual surgeon expertise and resource availability, emphasizing a balanced evaluation of benefits and challenges.
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Affiliation(s)
- Pietro Anoldo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80138 Naples, Italy;
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80138 Naples, Italy; (M.M.); (A.D.); (G.D.D.P.); (M.M.)
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80138 Naples, Italy; (M.M.); (A.D.); (G.D.D.P.); (M.M.)
| | - Mario Musella
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80138 Naples, Italy;
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80138 Naples, Italy; (M.M.); (A.D.); (G.D.D.P.); (M.M.)
| | - Marco Milone
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80138 Naples, Italy; (M.M.); (A.D.); (G.D.D.P.); (M.M.)
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Okamoto N, Misawa T, Shimada G, Saito T, Takiguchi S, Imamura K, Ohuchi M, Tanida T, Watanobe I, Fujii T, Takemasa I, Mizutani F, Matsubara T, Hayakawa S, Watanabe T, Okuya K, Takahashi H, Horikawa M, Wakabayashi G. Safety and short-term outcomes of robotic-assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study. Asian J Endosc Surg 2024; 17:e13251. [PMID: 37858296 DOI: 10.1111/ases.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the safety and short-term outcomes of robotic-assisted transabdominal preperitoneal repair for inguinal hernia in 12 pioneering hospitals in Japan. METHODS Clinical data of patients who underwent robotic-assisted transabdominal preperitoneal repair between September 1, 2016, and December 31, 2021 were collected. Primary outcome measures were intra-operative adverse events and post-operative complications, whereas secondary outcomes were surgical outcomes, including chronic pain, recurrence, and learning curve. RESULTS In total, 307 patients were included. One case of inferior epigastric arterial injury was reported; no cases of bowel or bladder injury were reported. Thirty-five seromas were observed, including four (1.3%) cases that required aspiration. The median operative time of a unilateral case was 108 minutes (interquartile range: 89.8-125.5), and post-operative pain was rated 1 (interquartile range: 0-2) on the numerical rating scale. In complicated cases, such as recurrent inguinal hernias and robotic-assisted radical prostatectomy-associated hernias, dissection and suture were safely achieved, and no complications were observed, except for non-symptomatic seroma. All patients underwent robotic procedures, and there was no chronic post-operative inguinal pain, although one case of hernia recurrence was reported. Regarding the learning curve, plateau performance was achieved after 7-10 cases in terms of operative time (P < .001). CONCLUSION Robotic-assisted transabdominal preperitoneal repair can be safely introduced in Japan. Regardless of the involvement of many surgeons, the mastery of robotic techniques was achieved relatively quickly. The advantage of robotic technology such as wristed instruments may expand the application of minimally invasive hernia repair for complicated cases.
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Affiliation(s)
- Nobuhiko Okamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Gen Shimada
- Hernia Center, St. Luke's International Hospital, Tokyo, Japan
| | - Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kiyotaka Imamura
- Department of Surgery, Teine Keijinkai Medical Center, Sapporo, Japan
| | - Masakazu Ohuchi
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tsukasa Tanida
- Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Ikuo Watanobe
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | | | | | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Hideki Takahashi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Horikawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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Okamoto N, Mineta S, Mishima K, Fujiyama Y, Wakabayashi T, Fujita S, Sakamoto J, Wakabayashi G. Comparison of short-term outcomes of robotic and laparoscopic transabdominal peritoneal repair for unilateral inguinal hernia: a propensity-score matched analysis. Hernia 2023; 27:1131-1138. [PMID: 36595086 DOI: 10.1007/s10029-022-02730-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aimed to compare perioperative outcomes of robotic and laparoscopic transabdominal peritoneal repair (TAPP) for unilateral inguinal hernia. METHODS This single institutional retrospective cohort study used de-identified data of patients who underwent robotic TAPP (R-TAPP) or laparoscopic TAPP (L-TAPP) for unilateral inguinal hernia between January 1, 2016 and October 31, 2021. Two cohorts were propensity matched, and data were analyzed. The learning curve was evaluated in the R-TAPP group. RESULTS Among 938 patients analyzed, 704 were included. After propensity-score matching, 80 patients were included in each group. The difference in operative time between R-TAPP and L-TAPP groups was 10 min (99.5 and 89.5 min, p = 0.087); however, console/laparoscopic time was similar (67 and 66 min, p = 0.71). The dissection time for medial-type hernia in the R-TAPP group was marginally shorter than that in the L-TAPP group (17 and 27 min, p = 0.056); however, there was no difference for lateral-type hernia (38.5 and 40 min p = 0.37). Perioperative variables, including estimated blood loss, postoperative hospital stay, and postoperative pain, had no significant difference, and chronic pain, which needed medication or intervention, was not observed in each group. The number of cases needed to achieve plateau performance was 7-10 in the R-TAPP group. CONCLUSION This study suggests that R-TAPP was safely introduced, and its perioperative outcomes were not inferior to those of L-TAPP. A shorter dissection time for medial-type hernia might be due to the robot's advantages, and a fast-learning curve could help with the early standardization of the procedure.
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Affiliation(s)
- N Okamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
| | - S Mineta
- Department of Surgery, Chiba Tokusyukai Hospital, Funabashi, Japan
| | - K Mishima
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Y Fujiyama
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - T Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - S Fujita
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - J Sakamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - G Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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