Resident training experience with robotic assisted transabdominal preperitoneal inguinal hernia repair

Ebeling, Peter A.; Beale, Katherine; Sickle, Kent R. Van; Al-Fayyadh, Mohammed J.; Willis, Ross E.; Marcano, Juan; Erwin, Dylan Z.; Kempenich, Jason W.

doi:10.1016/j.amjsurg.2019.11.014

Cited by 15 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1). 5,12,13,19–36 However, three studies were from the same centres and data were used only once 20,24,29 . Furthermore, one study included two sets of robotic data; therefore, each data were used independently 25 .…”

Section: Resultsmentioning

confidence: 99%

“…The mean body mass index (BMI) was 22.95, with a range of 16.4–40.4. There were 601 patients who underwent bilateral repairs, representing 38.8% of those that reported on laterality (601/1550) 12,13,21,23–25,27,28,30–32,35 . Of the studies that mentioned the types of mesh used, the majority used the Progrip mesh (Medtronic, Minneapolis, USA) (61.5%, 8/13) 12,13,19,24,25,30–32 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

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

show abstract

“… 9 , 20 However, a recent R-TAPP study of 27 residents at PGY levels 2 – 4 and two attending surgeons reported a longer average operative time for residents (53.0 min vs. 30.8 min; p = 0.01) compared to attending surgeons. 18 The same study showed that residents who self-reportedly completed ≤ 10 cases had lower mean robotic-skill assessment scores, while those who completed ≥ 30 cases had higher mean scores. This shows improved autonomy to residents as their extent of involvement increases overtime, which can be reflective of the increased attending surgeon’s comfort level with RIHR as they reach their own learning curve.…”

Section: Discussionmentioning

confidence: 89%

“…Prior studies have reported urinary retention rates after RIHR within the range of 3.3% to 10.2% with some reportable similarity to LIHR. 8 , 9 , 15 , 17 , 18 The second most prevalent complication was chronic pain in 11 patients (2.6%). Prior studies have reported 2.4 to 14.1% rates of inguinodynia after RIHR with some reportable similarity to LIHR.…”

Section: Discussionmentioning

confidence: 99%

Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

Awad

Buzalewski

Anderson

et al. 2020

JSLS

View full text Add to dashboard Cite

Background: Robotic inguinal hernia repair is the latest iteration of minimally invasive herniorrhaphy. Previous studies have shown expedited learning curves compared to traditional laparoscopy, which may be offset by higher cost and longer operative time. We sought to compare operative time and direct cost across the evolving surgical practice of 10 surgeons in our healthcare system. Methods: This is a retrospective review of all transabdominal preperitoneal robotic inguinal hernia repairs performed by 10 general surgeons from July 2015 to September 2018. Patients requiring conversion to an open procedure or undergoing simultaneous procedures were excluded. The data was divided to compare each surgeon’s initial 20 cases to their subsequent cases. Direct operative cost was calculated based on the sum of supplies used intra-operatively. Multivariate analysis, using a generalized estimating equation, was adjusted for laterality and resident involvement to evaluate outcomes. Results: Robotic inguinal hernia repairs were divided into two groups: early experience (n = 167) and late experience (n = 262). The late experience had a shorter mean operative time by 17.6 min (confidence interval: 4.06 – 31.13, p = 0.011), a lower mean direct operative cost by $538.17 (confidence interval: 307.14 – 769.20, p < 0.0001), and fewer postoperative complications (p = 0.030) on multivariate analysis. Thirty-day readmission rates were similar between both groups. Conclusion: Increasing surgeon experience with robotic inguinal hernia repair is associated with a predictable reduction in operative time, complication rates, and direct operative cost per case. Thirty-day readmission rates are not affected by the learning curve.

show abstract

“…Prior to this time, all robotic cases were performed by only two surgeons. By the end of the study period, a total of seven surgeons were performing robotic hernia repairs, four of which were still in the learning phase (< 30 cases completed)[19]. The participating surgeons had diverse backgrounds and experience level: one was an expert in abdominal wall reconstruction and hernia repair, two were trained in minimally invasive and bariatric surgery, three were non-fellowship trained general surgeons, and one was a transplant surgeon.…”

mentioning

confidence: 99%

Robotic abdominal wall repair: adoption and early outcomes in a large academic medical center

et al. 2021

View full text Add to dashboard Cite

Robotic-assisted abdominal wall repair (RAWR) has seen an exponential adoption over the last 5 years. Skepticism surrounding the safety, efficacy, and cost continues to limit a more widespread adoption of the platform. We describe our initial experience of 312 patients undergoing RAWR at a large academic center. A retrospective review of all patients undergoing any RAWR from July 1, 2016 to March 18, 2020 was completed. Patient specific, operation specific, and 30-day outcomes specific data were collected. Univariate analysis and multivariate logistic regression were used to assess factors associated with 30-day complications. There was a steady adoption of RAWR over the study period. A total of 312 patient were included, 138 (44%) were abdominal wall repairs and 174 (56%) were inguinal repairs. The mean age of the cohort was 54.2 years (SD 16), 69% were males, and the mean BMI was 29 kg/m 2 (SD 4.8). There were two reported intraoperative events and nine operative conversions. 60 patients had at least one complication at 30-days. These include: 52 seromas, 4 hematomas, 2 surgical-site infections, 1 deep venous thrombus, and 1 recurrence at 30-days. BMI, type of hernia, and sex were not associated with complications at 30-days. The use of absorbable mesh, longer hospital stay, operative conversion, previous repair, and expert hernia surgeon were significant predictors of 30-day complications. Age, operative conversion, and previous repair were the only predictors of 30-day complications on multivariate regression. Our initial experience of 312 patients demonstrates the adoption and comparable short-term outcomes for a wide variety of robotic-assisted hernia repairs.

show abstract

Resident training experience with robotic assisted transabdominal preperitoneal inguinal hernia repair

Cited by 15 publications

References 11 publications

Robotic inguinal hernia repair: systematic review and meta‐analysis

Robotic inguinal hernia repair: systematic review and meta‐analysis

Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

Robotic abdominal wall repair: adoption and early outcomes in a large academic medical center

Contact Info

Product

Resources

About