Novel robot‐assisted laparoscopic total extra‐peritoneal repair with primary fascial closure plus pre‐peritonea mesh for large groin defects

Abstract

Background:Since the introduction of robot-assisted laparoscopic surgery, a variety of conventional laparoscopic procedures have been explored via this approach. In the robotic era, most of the reported robot-assisted laparoscopic hernia repairs were performed with the trans-abdominal pre-peritoneal approach.According to the evidence extrapolated from laparoscopic ventral hernia repair, simultaneous fascial defect closure and mesh repair can significantly decrease the risk of seroma formation and recurrence over those without fascial closure.Therefore, we describe our novel technique of robot-assisted total extraperitoneal (TEP) repair with primary fascial closure and pre-peritoneal mesh and its preliminary clinical outcomes. Methods: We retrospectively reviewed our prospectively collected hernia database from October 2017 to July 2019, which included 26 consecutive patients with primary or recurrent groin hernias. Patients' baseline characteristics and perioperative outcomes were compared and analyzed. Perioperative factors included operative time, visual analog scale (VAS) score (0-100), hospital stay, perioperative complications, time to return to normal activity, and the modified Medical Outcome Study (MOS; item 3-12/36 items) score. Results: All procedures were completed successfully without conversion to open or conventional laparoscopic surgery. The patients' age ranged from 28 to 74 years (median 57.5). The mean operative time was 115 minutes (range 95-172 min). There were no major procedure-related complications. Only four cases experienced asymptomatic seromas, which were detected by ultrasonography; and all resolved spontaneously within 6 weeks after the operation. The VAS and modified MOSs revealed quick recovery after robot-assisted endoscopic TEP repair.Conclusions: Robot-assisted endoscopic TEP repair combined with primary fascial closure and pre-peritoneal mesh is a safe and feasible technique for groin hernia repair.

Risk Factors for Conversion in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

“…Yu and colleagues performed robotic TEP operation on 26 patients with hernia defect diameters >3 cm, and no conversion was observed. However, data on the distribution of hernia types and reduction and transection of large indirect hernia sac were not included 33…”

“…However, data on the distribution of hernia types and reduction and transection of large indirect hernia sac were not included. 33 Large hernia defects cause difficulty in opening the extraperitoneal space and conversion because of the presence of the bowel and omentum inside the hernia sac. Conversion may also be seen because of the collapse of the extraperitoneal area because of large PTs formed during large hernia sac dissection causing pneumoperitoneum.…”