V-015 ROBOTIC TARUP: TECHNICAL DETAILS AND INNOVATIVE METHOD OF FIXATION

Aim

With the recent evolution of minimally invasive hernia repairing techniques, robotic platform has exponentially gained consensus in the field of abdominal wall surgery, leading to the placement of retromuscolar synthetic meshes avoiding the need of extensive tissue dissection as the open approach.

Our aim was to describe the introduction of Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (TARUP) at a referral centre for advanced mini-invasive surgery, by reporting the preliminary experience and the technical aspects of the procedure.

Material & Methods

We present a case of a 3 cm umbilical defect associated to supraumbilical diastasis in a young man undergoing TARUP with the Da Vinci Xi system. The robotic boom was placed on the patient's right side, with three trocars on the anterior axillary line. The outline for the mesh was marked by centering the hernia defect with transcutaneous needles to delineate the extent of dissection corresponding to mesh area. Intra-abdominal pressure was of 8–12 mmHg. A retromuscolar plane was created starting from the incision of the ipsilateral posterior rectus sheat. The hernia content was reduced. The junction between the anterior and posterior rectus fascia was incised to cross-over the linea alba and continue the dissection controlaterally. A 15×15 cm polypropylene mesh was positioned in the retrorectus space and fixed with cyanoacrylic glue tack.

Results

Intervention lenght was of 100 minutes. No intra- or post-operative complications occurred.

At present, no early recurrences were observed.

Conclusions

Robotic TARUP represents a safe and reproducible alternative in selected cases where retromuscolar mesh is preferred.

V-016 PARAHIATAL HERNIA: A RARE CASE OF DIAPHRAGMATIC HERNIA ROBOTICALLY REPAIRED

Aim

Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair.

We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures.

Material and Methods

A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use.

Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement.

Results

The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged.

At six months no recurrences were detected.

Conclusions

Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.

V-023 R-TAPP AS A TRAINING MODEL IN ROBOTIC SURGERY

Aim

The main aim of the project will be evaluating the effectiveness of an experimental structured didactic program in robotic surgery in filling the training gap caused by the pandemic. We intend to evaluate how establishing a training pathway could improve young surgeons’ robotic skills and implement their participation in robotic procedures during the COVID-19 pandemic. We will also evaluate the learning curve of robotic transabdominal preperitoneal inguinal hernia repair (TAPP) for young surgeons with limited experience as first operators at the dual console.

Matherials and Methods

We designed an experimental stepwise training program in robotic surgery that starts from a first step of theoretical and laboratory lessons, followed by a second phase of bedside assistance training, and finally the completion of low complexity procedures by the trainees proctored at the dual console by senior surgeons. Robotic TAPP was selected as training model. The performance of each trainee will be registered in an evaluation data sheet and Learning scores will be recorded by the tutor with the evaluation of 6 corner steps of the procedure.

Results

Preliminary results showed improved technical skills and increased team spirit and wellbeing.

Conclusions

TAPP is a good training model because involves technical steps useful for more complex procedures. The robotic dual console represent an extraordinary training tool and a structured training program positively impacts technical skills and could help filling the training gap caused by the pandemic.