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Del Castillo-Diez F, Pascual-Migueláñez I, Leivar-Tamayo A, García-Sancho Téllez L, Díaz-Domínguez J. "Fully endoscopic preperitoneal ascending suprapubic approach for minimally invasive repair of anterior and lateral abdominal wall hernias". Hernia 2024:10.1007/s10029-024-03070-4. [PMID: 38970697 DOI: 10.1007/s10029-024-03070-4] [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: 12/06/2023] [Accepted: 05/02/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE The aim of this work is to describe the rational, feasibility and clinical and Quality-of-life improvement results of a fully endoscopic preperitoneal repair for midline and lateral abdominal wall hernias, starting from the space of Retzius in a "bottom-to-up" approach. METHODS An observational prospective data-collected and quality of life study is performed in selected patients with less than 10 cm. in diameter midline and lateral abdominal wall hernias. A suprapubic upward e-TEP technique from a previously dissected Retzius space, is performed in all cases. The surgical goal is to perform a total free-tension abdominal wall reconstruction followed by a prosthetic hernioplasty. Clinical Data is classified in preoperative, intraoperative, and postoperative variables, including a quality-of-life clinical evaluation based on an improvement of HerQLes score. RESULTS A total of 30 patients underwent this approach from September 2017 to October 2022 in a single-surgeon practice. A total restoration of the previous abdominal wall anatomy and a prosthetic repair were achieved in all cases. The mean operative time was 142.53 min, with a significant shorter time in lateral hernias approach. Minor complications (Clavien-Dindo I) were collected in 10% of the patients. Major complications (Clavien-Dindo IIIb) occurred in 6.66% of the patients. The mean pain at discharge was 1.83 VAS, with a significant lower pain in M-eTEP approach for lateral hernias. The mean hospital stay was 42.4 h. No seroma, hematoma, chronic pain, or recurrence was observed in the mean follow-up (20.33 months). A clinical and quality of life improvement was found in 92.9% of the patients, measured by a minimal clinical important difference (MCID) between preoperative and postoperative HerQLes score. CONCLUSION Despite being a technically demanding approach, the results obtained by this approach are compatible in safety and feasibility with other minimally invasive preperitoneal hernia repair techniques, in addition to obtaining a significant improvement in the quality of life of patients.
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Affiliation(s)
- Federico Del Castillo-Diez
- General and Digestive Surgery Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
| | - I Pascual-Migueláñez
- General and Digestive Surgery Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - A Leivar-Tamayo
- Urology Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - L García-Sancho Téllez
- General and Digestive Surgery Department, Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - J Díaz-Domínguez
- General and Digestive Surgery Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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Murgante Testa N, Mongelli F, Sabbatini F, Iaquinandi F, Prouse G, Pini R, La Regina D. Safety and feasibility of emergency robot-assisted transabdominal preperitoneal repair for the treatment of incarcerated inguinal hernia: A retrospective study. World J Surg 2024; 48:622-628. [PMID: 38501558 DOI: 10.1002/wjs.12063] [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: 11/28/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND Few studies assessed robotic in emergency setting and no solid evidence was demonstrated. The aim of this study was to evaluate the feasibility and safety of robot-assisted transabdominal preperitoneal (R-TAPP) repair for the treatment of incarcerated inguinal hernia. METHODS We retrospectively searched from a prospectively maintained database patients who underwent R-TAPP or open surgery for incarcerated inguinal hernias from January 2018 to March 2023. The primary endpoint was to assess safety and feasibility of the R-TAPP compared to the standard approach. For eligible patients, data was extracted and analyzed using a propensity score-matching (PSM). RESULTS Thirty-four patients were retrieved from our database, 15 underwent R-TAPP, while 19 underwent open surgery. Mean age was 73.1 ± 14.6 years, 30 patients (88.2%) were male and mean BMI was 23.5 ± 3.2 kg/m2. No intraoperative complication occurred. Three cases requiring small bowel resection were all in the open surgery group (p = 0.112). The operative time was 108 ± 31 min versus 112 ± 31 min in the R-TAPP and open surgery groups (p = 0.716). Seven postoperative complications occurred, only one classified as severe was in the open surgery group. The length of hospital stay was 2.9 ± 1.8 in the R-TAPP versus 4.2 ± 2.3 min in the open surgery group (p = 0.077). PSM analysis showed similar postoperative outcomes and costs in both groups. CONCLUSIONS Despite its limitations, our study appears to endorse the safety and feasibility of the robotic-assisted treatment for incarcerated inguinal hernia. This approach yielded comparable results to open surgery, albeit in a limited number of patients, suggesting it might be a viable alternative.
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Affiliation(s)
- Nicole Murgante Testa
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Flaminia Sabbatini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Fabiano Iaquinandi
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Giorgio Prouse
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Pini R, Mongelli F, Iaquinandi F, Gaffuri P, Previsdomini M, Cianfarani A, La Regina D. Switching from robotic-assisted extended transabdominal preperitoneal (eTAPP) to totally extraperitoneal (eTEP) hernia repair for umbilical and epigastric hernias. Sci Rep 2024; 14:1800. [PMID: 38245577 PMCID: PMC10799892 DOI: 10.1038/s41598-024-52165-6] [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: 05/24/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
Our study aimed to assess the safety and effectiveness of the robotic-assisted extended totally extraperitoneal (eTEP) repair compared to transabdominal preperitoneal (eTAPP) repair with a suprapubic trocar insertion to treat umbilical and epigastric hernias. On a prospectively maintained database, we identified patients who underwent either eTEP or eTAPP for treating umbilical and epigastric hernias. During the study period, 53 patients were included, 32 in the eTEP group and 21 in the eTAPP group. The mean age was 59.0 ± 13.9 years, 45 patients (84.9%) were male, and the mean BMI was 28.0 ± 5.9 kg/m2. Most hernias were umbilical (81.1%) and primary (83.0%). The operative time for eTEP was slightly shorter than for eTAPP (106 ± 43 min vs. 126 ± 74 min, p = 0.232). Postoperatively, only one case of bleeding and one seroma were recorded. No complication occurred during a mean follow-up of 11.3 ± 6.4 months in the eTEP group and 20.5 ± 9.7 months in the eTAPP group. In conclusion, our study showed that the eTEP with suprapubic approach was safe and feasible in the treatment of epigastric and umbilical hernias. According to our experience, shorter operative time, integrity of the posterior layers and increased overlap size are the main surgical reasons of switching from eTAPP to eTEP.
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Affiliation(s)
- 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, 6500, Lugano, Switzerland.
| | - Fabiano Iaquinandi
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Marco Previsdomini
- Intensive Care Unit, Bellinzona e Valli Regional Hospital, EOC, 6500, Bellinzona, Switzerland
| | - Agnese Cianfarani
- 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, 6500, Lugano, Switzerland
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Bertoni MV, Marengo M, Garofalo F, Volontè F, La Regina D, Gass M, Mongelli F. Robotic-Assisted Versus Laparoscopic Revisional Bariatric Surgery: a Systematic Review and Meta-analysis on Perioperative Outcomes. Obes Surg 2021; 31:5022-5033. [PMID: 34410582 DOI: 10.1007/s11695-021-05668-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Abstract
This systematic review and meta-analysis investigated the role of robotic-assisted surgery in patients undergoing revisional bariatric surgery (RBS). According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar was performed: (("sleeve"AND "gastr*")OR "bariatric"OR "gastric bypass")AND("robot*"OR "DaVinci"OR "Da Vinci")AND("revision*"OR "conversion*"). In this review, six studies with 29,890 patients were included (2459 in the robotic group). No difference in postoperative complications (RR 1.070, 95%CI 0.930-1.231, p = 0.950), conversions to open surgery (RR 1.339, 95%CI 0.736-2.438, p = 0.339), length of stay (SMD - 0.041, 95%CI - 0.420-0.337, p = 0.831) or operative time (RR 0.219, 95%CI - 0.539-0.977, p = 0.571) was found. This systematic review and meta-analysis showed no significant advantage of robotic-assisted RBS; on the other hand, it showed a non-inferior efficacy compared to standard laparoscopy.
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Affiliation(s)
- Maria Vittoria Bertoni
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland
| | - Michele Marengo
- Department of Surgery, Bellinzona e Valli Regional Hospital, via Ospedale 10, 6500, Bellinzona, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesco Volontè
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland.,Department of Surgery, Sant'Anna Clinic, Via Sant'Anna 1, 6924, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Bellinzona e Valli Regional Hospital, via Ospedale 10, 6500, Bellinzona, Switzerland
| | - Markus Gass
- Department of Surgery, Cantonal Hospital of Lucerne, Spitalstrasse , 6000, Lucerne , Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, 6000, Lucerne, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland.
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