Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR)

Gómez-Menchero, Julio; Jurado, Juan Francisco Guadalajara; Grau, J. M. Suárez; Luque, Juan Antonio Bellido; Moreno, Joaquin Luis García; Água, I. Alarcón del; Morales-Conde, Salvador

doi:10.1007/s00464-018-6070-y

Cited by 34 publications

(8 citation statements)

References 24 publications

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“…Robot assisted repair offered technical advantages in the closure of the hernia defect and a higher rate of defect closure was achieved with robot assisted repair compared with laparoscopic repair. However, the operating time was significantly longer for robot assisted repair compared with open repair with a mean difference of 84 min, and laparoscopic repair with a mean difference of 52 min (40).…”

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment Options for Abdominal Rectus Diastasis

2019

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Background: Abdominal rectus diastasis is a condition where the abdominal muscles are separated by an abnormal distance due to widening of the linea alba causing the abdominal content to bulge. It is commonly acquired in pregnancies and with larger weight gains. Even though many patients suffer from the condition, treatment options are poorly investigated including the effect of physiotherapy and surgical treatment. The symptoms include pain and discomfort in the abdomen, musculoskeletal and urogynecological problems in addition to negative body image and impaired quality of life. The purpose of this review was to give an overview of treatment options for abdominal rectus diastasis.Results: The first treatment step is physiotherapy. However, evidence is lacking on which regimen to use and success rates are not stated. The next step is surgery, either open or laparoscopic, and both surgical approaches have high success rates. The surgical approach includes different plication techniques. The recurrence and complication rates are low, complications are minor, and repair improves low back pain, urinary incontinence, and quality of life. Robotic assisted surgery might become a possibility in the near future, but data are still lacking.Conclusions: Evidence on what conservatory treatment to use is sparse, and more research needs to be done. Both open and laparoscopic surgery have shown positive results. Innovative treatment by robotic assisted laparoscopic surgery has potential, however, more research needs to be done in this area as well. An international guideline for the treatment of rectus diastasis could be beneficial for patients and clinicians.

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Section: Surgical Treatmentmentioning

confidence: 99%

Treatment Options for Abdominal Rectus Diastasis

2019

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“…The current consensus seems to be that modern procedures must combine the advantages of open repair (morphologic and functional repair, extraperitoneal mesh, low recurrence rate) with those of minimally invasive procedures (fewer complications) [ 20 ]. The conventional laparoscopic linea alba stapler repair (LIRA) procedure is a step in this direction; the hernia gap is closed at the fascial level, but the mesh is still implanted in the IPOM position [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic hernia repair II. English version

Baur

Ramser

Keller

et al. 2021

Chirurg

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Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.

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“…Konsensfähig scheint aktuell die Erkenntnis, dass moderne Verfahren die Vorteile der offenen Reparation (morphologische und funktionelle Reparation, extraperitoneales Netz, geringe Rezidivrate) mit denen der minimal-invasiven Verfahren (weniger Komplikationen) vereinen müssen [ 20 ]. Das konventionell-laparoskopische LIRA(„laparoscopic line alba stapler repair“)-Verfahren ist ein Schritt in diese Richtung, die Bruchlücke wird auf Faszienebene verschlossen, das Netz wird allerdings nach wie vor in IPOM-Position implantiert [ 21 ].…”

Section: Diskussionunclassified

Robotische Hernienchirurgie II

Baur

Ramser

Keller

et al. 2021

Chirurg

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ZusammenfassungDie endoskopische Versorgung von Umbilikal- und Inzisionalhernien hat sich in den vergangenen 30 Jahren an die Limitationen der konventionellen laparoskopischen Instrumente angepasst. Dazu gehört die Entwicklung von Netzen für die intraperitoneale Lage (intraperitoneales Onlay-Mesh, IPOM) mit antiadhäsiven Beschichtungen; allerdings kommt es bei einem beträchtlichen Teil dieser Patienten doch zu Adhäsionen. Minimal-invasive Verfahren führen zu weniger perioperativen Komplikationen, bei einer etwas höheren Rezidivrate. Mit den ergonomischen Ressourcen der Robotik, die abgewinkelte Instrumente anbietet, besteht erstmals die Möglichkeit, Netze minimal-invasiv in unterschiedliche Bauchdeckenschichten zu implantieren und gleichzeitig eine morphologische und funktionelle Rekonstruktion der Bauchdecke zu erreichen. In diesem Videobeitrag wird die Versorgung von Ventral- und Inzisionalhernien mit Netzimplantation in den präperitonealen Raum (robotische ventrale transabdominelle präperitoneale Patchplastik, rv-TAPP) sowie in den retrorektalen Raum (r-Rives bzw. robotische transabdominelle retromuskuläre umbilikale Patchplastik [r-TARUP]) präsentiert. Es werden die Ergebnisse einer Kohortenstudie an 118 konsekutiven Patienten vorgestellt und im Hinblick auf den Mehrwert der robotischen Technik in der Extraperitonealisierung der Netze und in der Weiterbildung diskutiert.

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Laparoscopic intracorporeal rectus aponeuroplasty (LIRA technique): a step forward in minimally invasive abdominal wall reconstruction for ventral hernia repair (LVHR)

Cited by 34 publications

References 24 publications

Treatment Options for Abdominal Rectus Diastasis

Treatment Options for Abdominal Rectus Diastasis

Robotic hernia repair II. English version

Robotische Hernienchirurgie II

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