Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database

Angus, Andrew; DeMare, Alexander M.; Iacco, Anthony

doi:10.1007/s00464-020-08020-6

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…No data with regard to patients who had previous prostatectomies were reported in the included studies. Recent papers showed that the robotic platform with its improved dexterity and enhanced high-definition three-dimensional image may be particularly helpful in the challenging dissection of the retro-pubic space in patients who had prior prostatectomies [ 36 , 37 ]. Those advantages offered by the robotic platform may expand the indications for minimally invasive inguinal hernia repair also for those cases which, nowadays, are performed only by expert laparoscopic surgeons.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

et al. 2021

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The aim of this study was to review the latest evidence on the robotic approach (RHR) for inguinal hernia repair comparing the pooled outcome of this technique with those of the standard laparoscopic procedure (LHR). A systematic literature search was performed in PubMed, Web of Science and Scopus for studies published between 2010 and 2021 concerning the comparison between RHR versus LHR. After screening 582 articles, 9 articles with a total of 64,426 patients (7589 RHRs) were eligible for inclusion. Among preoperative variables, a pooled higher ratio of ASA > 2 patients was found in the robotic group (12.4 vs 8.6%, p < 0.001). Unilateral hernia repair was more common in the laparoscopic group (79.9 vs 68.1, p < 0.001). Overall, operative time was longer in the robotic group (160 vs 90 min, p < 0.001); this was confirmed also in the sub-analysis on unilateral procedures (88 vs 68 min, p = 0.040). The operative time for robotic bilateral repair was similar to the laparoscopic one (111 vs 100, p = 0.797). Conversion to open surgery was 0% in the robotic group. The pooled rate of chronic pain and postoperative complications was similar between the groups. The standardized mean difference MD of the costs between LHR versus RHR was − 3270$ (95% CI – 4757 to − 1782, p < 0.001). In conclusion, laparoscopic and robotic inguinal hernia repair have similar safety parameters and postoperative outcomes. Robotic approach may require longer operative time if the unilateral repair is performed. Costs are higher in the robotic group.

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Section: Discussionmentioning

confidence: 99%

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

et al. 2021

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“…15 In fact, a recent propensitymatched analysis using the National Surgical Quality Improvement Program database matched patients undergoing RIHR who had a previous urologic pelvic surgery to those who did not have a history of previous urologic pelvic surgery and found no difference in complication rate, 30-day readmissions, recurrence rate, or postoperative complications. 11 Our limited cohort fared similarly well, with no significant intraoperative or postoperative complications. The 2 seromas and 1 hematoma in our cohort did not require intervention and were self-limiting with conservative treatment.…”

Section: Discussionmentioning

confidence: 59%

“…[5][6][7][8] More recently, r-TAPP inguinal hernia repair (RIHR) has started to gain traction in this subset of patients, especially with larger and more complex inguinal hernias. [9][10][11] Nonetheless, the purported advantages of RIHR in patients presenting after radical prostatectomy have not been well-established. As the benefits of robotic hernia surgery continue to be elucidated, there will likely be a gradual adoption of the platform in the coming years.…”

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confidence: 99%

Robotic Inguinal Hernia Repair After Prostatectomy: How to Navigate Safely

Salas-Parra

Lima

Pereira

et al. 2021

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: In recent decades, minimally invasive approaches have found their place in treating a specific subset of patients with inguinal hernias, predominantly those with recurrent or bilateral disease. Classically, prior history of urologic pelvic operations, such as prostatectomy, has been listed as relative contraindication for minimally invasive inguinal hernia repair. As the adoption of the robotics platform continues to grow, we aim to outline a feasible robotic-assisted inguinal hernia repair technique in patients with previous prostatectomies. We report the outcomes of 15 patients who underwent repair at 2 institutions.Methods: This is a retrospective case series of 15 patients who underwent robotic transabdominal preperitoneal approach repair of their inguinal hernias after prostatectomy. Demographics, intraoperative variables, and outcomes of our cases are described.Results: Fifteen patients were included in our cohort. All patients had a history of prostatectomy (7 open, 2 laparoscopic, and 6 robotic) due to prostate cancer. Median age was 70 years old (range: 60 to 89 y), with a median body mass index of 26.3 kg/m 2 (range: 20.5 to 37.4 kg/m 2 ). Hernia defects were bilateral in 6 patients and unilateral in the remaining 9 (right; 6, left; 3). The shortest interval between prostatectomy and subsequent hernia repair was 4 months (range: 4 to 216 mo). The median operative time was 139 min (range: 91 to 281 min). All defects were repaired using a polypropylene mesh except in 1 case, where a coated monofilament polyester mesh was used after having a large peritoneal defect to close, preventing future adhesions to the bowel. Mesh sizes used were large (16×11 cm), extra-large (17×12 cm) for anatomic mesh, and 20×15 cm for the monofilament polyester mesh. The mesh was fixed in 14 of 15 cases. Fixation was accomplished with absorbable suture (n = 13), barbed suture (n = 1), and fibrin sealant (n = 1). Peritoneal closure was always performed using a continuous running v-loc suture. There were no documented major intraoperative complications, no 30-day readmission, or recurrences recorded within the follow-up period. Postoperatively, only 2 seromas and 1 hematoma were documented during the follow-up period.Conclusions: Robotic inguinal hernia repairs in patients with previous prostatectomy is safe and feasible in most patients. Larger patient series are needed to confirm these findings.

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“…They concluded that L-TAPP repair may be a valuable alternative to open hernioplasty [29]. In contrast, Angus et al showed that R-TAPP might be an alternative to open repair in patients with a history of prior urologic pelvic operation [30]. Additionally, Bitnner and Leblanc et al reported that operation times were longer for robotic hernia repair patients than laparoscopic patients, but there was no difference in the safety [31,32].…”

Section: Discussionmentioning

confidence: 99%

The Experience of Robot-assisted Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Following Robot-assisted Laparoscopic Radical Prostatectomy: A Cohort Study

Funamizu

Mineta

Ozaki

et al. 2022

Preprint

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BackgroundThere are no reports of robot-assisted laparoscopic transabdominal preperitoneal inguinal hernia repair (R-TAPP) for the patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP). AimTo evaluate the feasibility and safety of R-TAPP in patients who underwent RALP for postprostatectomy inguinal hernia (PIH).MethodsThis is a prospective, single-center retrospective cohort study. R-TAPP was conducted in 74 consecutive patients from September 2016 to March 2020. Except for women and patients who underwent previous abdominal surgery, 70 patients were classified into two groups based on the absence or presence of PIH (PIH group or non-PIH group). The data were retrospectively compared to those who had not undergone RALP.ResultsSeventy patients were reviewed. Among them, 22.9% had previously undergone RALP. We identified 22 lesions in 16 patients (unilateral in 10; bilateral in 6) in the PIH group, and 67 lesions in 54 patients (unilateral in 41; bilateral in 13) in the non-PIH group. The PIH group showed a longer median operation time compared to the non-PIH group. However, postoperative complications—including seroma formation, hematoma, and surgical site infections—were not significantly different between the groups. There were no recorded vascular, bladder, or spermatic cord injuries in either group. There was no conversion to laparoscopic or open surgery in either group. The estimated blood loss was small, and hospitalization duration was one day in all cases. Moreover, there were no hernia recurrences within the 90-day follow-up period in either group.ConclusionR-TAPP seem to be a feasible and safe approach for inguinal hernia repair, even in patients who underwent RALP for prostate cancer.

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Evaluating outcomes for robotic-assisted inguinal hernia repair in males with prior urologic surgery: a propensity-matched analysis from a national database

Cited by 9 publications

References 19 publications

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

Robotic Inguinal Hernia Repair After Prostatectomy: How to Navigate Safely

The Experience of Robot-assisted Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Following Robot-assisted Laparoscopic Radical Prostatectomy: A Cohort Study

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