This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Aim
Robotic surgery using the da Vinci system has markedly increased worldwide. However, robotic inguinal hernia repair remains unpopular outside the United States. We introduced and evaluated a robotic transabdominal preperitoneal repair (R‐TAPP) technique for inguinal hernia in our hospital.
Methods
First, we designed a task protocol according to the surgical results of 388 laparoscopic TAPP (L‐TAPP) procedures performed during the 4 years prior to introducing R‐TAPP. Our task protocol included several time limitations during a step‐wise procedure: creating the peritoneal flap (<60 minutes), mesh placement with fixation (<30 minutes), and peritoneal suture closure (<30 minutes) under experienced supervision. We investigated the preliminary clinical results of R‐TAPP performed by a single operator between December 2018 and January 2020.
Results
We identified 27 lesions in 20 patients (unilateral in 13 and bilateral in seven). According to the Japan Hernia Society Classification, our cohort included eight type I, five type II, and seven bilateral hernias (nine type I, four type II, and one type IV). The median operation time was 124 minutes (range, 81‐164 minutes), and the median console operation time was 85 minutes (range, 50‐132). The median time required for the peritoneal incision was 30 minutes (range, 18‐54 minutes), that for mesh placement (including tucking) was 13 minutes (range, 7‐27 minutes), and that for peritoneal suturing was 9 minutes (range, 3‐20 minutes).
Conclusion
Our preliminary results suggest that our task protocol for R‐TAPP is feasible. However, refinement of our task protocol is essential for standardization.
These results suggest that LSC with CDOS is a promising approach that can avoid dissection of Calot's triangle and achieve the complete removal of the gallbladder cavity in patients with severe cholecystitis.
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