Predictors of Robotic Versus Laparoscopic Inguinal Hernia Repair

Vossler, John D.; Pavlosky, K. Keano; Murayama, Sarah M.; Moucharite, Marilyn; Murayama, Kenric M.; Mikami, Dean J.

doi:10.1016/j.jss.2019.03.056

Cited by 21 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…New technologies may be rapidly adopted in the absence of supporting evidence to establish their superiority compared with existing procedures . Despite seemingly exponential increase in the robotic approach to inguinal hernia repair with concurrent static numbers of laparoscopic approach, current comparative literature to support this practice has remained sparse. Indeed, studies supportive of the robotic over laparoscopic approach to date are hindered by single-group cohorts limited to quality of life measures, single-surgeon experiences with small patient groups and clinical differences of limited practical or meaningful value, multicenter retrospective studies with heterogeneous comparison groups, and large administrative database reports lacking in operative granularity and limited in their scope to address salient issues related to hernia recurrence and quality of life …”

Section: Discussionmentioning

confidence: 99%

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Despite rapid adoption of the robotic platform for inguinal hernia repair in the US, to date, no level I trials have ever compared robotic inguinal hernia repair to laparoscopic repair. This multicenter randomized clinical trial is the first to compare the robotic platform to laparoscopic approach for minimally invasive inguinal hernia repair.OBJECTIVE To determine whether the robotic approach to inguinal hernia repair results in improved postoperative outcomes compared with traditional laparoscopic inguinal hernia repairs. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, single-blinded, prospective randomized clinical pilot study was conducted from April 2016 to April 2019, with a follow-up duration of 30 days in 6 academic and academic-affiliated sites. Enrolled in this study were 113 patients with a unilateral primary or recurrent inguinal hernia. After exclusions 102 remained for analysis.INTERVENTIONS Standard laparoscopic transabdominal preperitoneal repair or robotic transabdominal preperitoneal repair. MAIN OUTCOMES AND MEASURESMain outcomes included postoperative pain, health-related quality of life, mobility, wound morbidity, and cosmesis. Secondary outcomes included cost, surgeon ergonomics, and surgeon mental workload. A primary outcome was not selected because this study was designed as a pilot study. The hypothesis was formulated prior to data collection.RESULTS A total of 102 patients were included in the study (54 in the laparoscopic group, mean [SD] age, 57.2 [13.3] years and 48 [88.9%] male; 48 in the robotic group, mean [SD] age, 56.1 [14.1] years and 44 [91.6%] male). There were no differences at the preoperative, 1-week, or 30-day points between the groups in terms of wound events, readmissions, pain as measured by the Visual Analog Scale, or quality of life as measured by the 36-Item Short Form Health Survey. Compared with traditional laparoscopic inguinal hernia repair, robotic transabdominal preperitoneal repair was associated with longer median (interquartile range) operative times (75.5 [59.0-93.8] minutes vs 40.5 [29.2-63.8] minutes, respectively; P < .001), higher median (interquartile range

show abstract

Section: Discussionmentioning

confidence: 99%

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, with the advent of the robotic system, given an increased manoeuvrability, improved vision with 10 times magnification, three‐dimensional views, enhanced endo‐wrist dexterity and a shorter learning curve, robotic hernia repair is becoming more popular and being utilized by skilled surgeons 3,4,6,7 . Worldwide, there has been an exponential increase in the use of the robot through the surgical specialties, with nearly a 175% increase over a 5‐year period and 625% increase in the USA alone 8,9 …”

Section: Introductionmentioning

confidence: 99%

Robotic inguinal hernia repair: systematic review and meta‐analysis

Qabbani

Aboumarzouk

ElBakry

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background We aimed to conduct a systematic review and meta‐analysis of RHR's efficiency and safety, in addition to comparison between open and laparoscopic techniques. Methods A literature review was conducted from 2000 to 2020 including studies reporting on their centre's outcomes for robotic hernial repairs. A meta‐analysis was conducted. For continuous data, Mantel–Haenszel chi‐squares test was used and inverse variance was used for dichotomous data. Results In total, 19 studies were included. A total of 8987 patients were treated for hernia repairs, 4248 underwent open repairs, 2521 had robotic repairs and 1495 had laparoscopic repair. Cumulative analysis of robotic series: The overall average operative time was 90.8 min (range 25–180.7 min). The overall conversation rate was 0.63% (10/1596). The overall complication rate was 10.1% (248/2466). The overall recurrence rate was 1.2% (14/1218). Readmission rate was 1.6% (28/1750). Comparative meta‐analysis outcomes include robotic versus open and robotic versus laparoscopic. Robotic versus open: The robotic group had significantly longer operative times and less readmission rates. There was no difference between the two groups regarding complications, post‐operative pain occurrence and hernia recurrence rates. Robotic versus laparoscopic: The robotic group had significantly longer operative times and less complications. There was no difference regarding post‐operative pain occurrence, hernia recurrence rates or readmission rates. Conclusion Robotic hernia repair is a safe and efficient technique with minimal complications and a short learning curve; however, it remains inferior to the standard open technique. It does, however, have a role in minimally invasive technique centres. A multicentre randomized control trial is required comparing robotic, open and laparoscopic techniques.

show abstract

“…Recently, the adoption of robotic surgery for inguinal hernia repair has increased exponentially, mainly in the USA. 1 The international guidelines for inguinal hernia management report that 100 supervised laparo‐endoscopic repairs are needed to achieve the same results as open mesh surgery techniques, such as the Lichtenstein procedure. 2 However, there are few reports evaluating the learning curve (LC) of robotic inguinal hernia repair (RIHR), and there is no consensus on the criteria for operating surgeons.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, the adoption of robotic surgery for inguinal hernia repair has increased exponentially, mainly in the USA 1 . The international guidelines for inguinal hernia management report that 100 supervised laparo‐endoscopic repairs are needed to achieve the same results as open mesh surgery techniques, such as the Lichtenstein procedure 2 .…”

Section: Introductionmentioning

confidence: 99%

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

Saito

Fukami

Komatsu

et al. 2021

Annals of Gastroent Surgery

View full text Add to dashboard Cite

The number of robotic inguinal hernia repair (RIHR) surgeries performed by younger surgeons and surgical residents has been growing worldwide. As a result, there has been growing interest in the pace at which surgeons develop their competencies. In Japan, the number of robotic surgeries with the double bipolar technique for gastric cancer is increasing. We devised an RIHR technique for a right‐hand‐dominant surgeon. This article describes the procedure and step‐by‐step instructions for this technique. We also assessed the learning curve of a surgeon experienced in the laparoscopic transabdominal preperitoneal (TAPP) approach and robotic gastrectomy. This was a retrospective review of 31 inguinal hernia patients (40 lesions) between December 2018 and April 2021 operated by a single surgeon. The cumulative summation technique (CUSUM) was used to construct a learning curve for robotic proficiency by analyzing the times for peritoneal flap creation, mesh placement, and peritoneal closure. The postoperative course, namely, the length of hospital stay, 30‐d complications, and 30‐d readmission rates, was evaluated. The CUSUM graph for the total time for each phase indicated an initial decrease at lesion 12 and another decrease at lesion 36, generating three distinct performance phases: learning (n = 12 procedures), competence (n = 24), and mastery (n = 4). Between the early and late periods, no significant differences in patient characteristics or surgical outcomes were found. The learning curve for this technique was divided into three performance phases, and the technique was safely achievable in 36 procedures by a surgeon with previous experience in laparoscopic TAPP.

show abstract

Predictors of Robotic Versus Laparoscopic Inguinal Hernia Repair

Cited by 21 publications

References 14 publications

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

Robotic inguinal hernia repair: systematic review and meta‐analysis

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

Contact Info

Product

Resources

About