Robotic TAPP inguinal hernia repair: lessons learned from 97 cases

Abstract

Objectives: minimally invasive inguinal hernia repair has proven advantages over open procedures including less pain and earlier return to normal activity. Robotic surgery adds ergonomics, a three-dimensional high definition camera and articulating instruments overcoming some laparoscopic limitations. We aimed to report the outcomes of the early experience of over 97 robotic inguinal hernia repairs performed by a referred surgical group in Brazil. Methods: a review of a prospective mantined database was conducted in patients submitted to robotic transabdominal preperitoneal (TAPP) inguinal hernia repairs between March 2016 and February 2020. Descriptive statistics were performed. Surgical outcomes data and patient follow-ups are reported. Results: retrospective chart review identified 97 patients submitted to robotic TAPP inguinal hernia repair. Mean age was 36.4 years, with median BMI of 26.9 kg/m2. Mean console time was 58 min (range 40-150) and patients were discharged within 24 hours of their stay in a majority of cases. Mesh was placed in all procedures and there were no conversion rates. Complications were low grade and no recurrence was seen after a mean follow-up of 642 days. Conclusion: this study represents to-date the first brazilian case series of robotic TAPP inguinal hernia repair. Our results encourage that robotic assisted TAPP inguinal hernia repair appears to be technically feasible and safe in experienced hands, with good outcomes achieving high health-related quality of life and low recurrence rates in the short and long term.

Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea

“…[ 18 ] Several articles have reported relatively long operation times but low postoperative complication rates and pain levels associated with robotic inguinal surgery. [ 16 , 17 , 19 , 20 ] The Da Vinci Xi system dramatically reduced robot docking time compared with the previous Si system. In our study, the actual docking time was about 2 min.…”

“…[ 11 , 12 , 13 , 14 ] The first report of robot-assisted hernia surgery was of a repair performed together with urologic procedures in 2014, and Dominguez et al reported the first robotic hernia surgery results. [ 1 , 15 ] Since then, robotic hernia surgery has been reported to reduce postoperative pain and facilitate ergonomic optimization for surgeons, and it has been attempted and adopted by surgeons worldwide [ 1 , 15 , 16 , 17 ].…”

Dual docking technique for robotic repair of simultaneous inguinal and umbilical hernia: A preliminary single center experience

“…14 In a standardized operating setting, a camera port is inserted into the abdominal cavity after umbilical access and two 8-mm robotic ports are placed either side lateral to the umbilicus, slightly above or below the umbilical line, with a minimum of 10 cm lateral to the supraumbilical port and 10 cm superior to the anterior superior iliac spine. 15,16 Similarly, the operating setting for the robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP) technique is performed in a standard way by the robotic surgeons:…”

“…Transabdominal preperitoneal (TAPP) approach has gained space so the preperitoneal space has started to be endorsed in minimally invasive inguinal hernia repair 14 . In a standardized operating setting, a camera port is inserted into the abdominal cavity after umbilical access and two 8‐mm robotic ports are placed either side lateral to the umbilicus, slightly above or below the umbilical line, with a minimum of 10 cm lateral to the supraumbilical port and 10 cm superior to the anterior superior iliac spine 15,16 …”

Robotic-assisted inguinal hernia repair: A historical review

“…Technology has rapidly advanced in the field of surgery especially in the past 10 years, which is thought to progress even more in the near future. Robots have increasingly gained popularity and would be the future of surgery according to some authors [27]. Considering the rapidly growing industry and the huge progress made in the field of artificial intelligence, it is difficult to keep oneself updated with the recent advances.…”