Robotic hernia repair II. English version

Baur, Johannes; Ramser, Michaela; Keller, Nicola; Muysoms, Filip; Dörfer, Jörg; Wiegering, Armin; Eisner, Lukas; Dietz, Ulrich

doi:10.1007/s00104-021-01479-6

Cited by 10 publications

(4 citation statements)

References 27 publications

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“…Accordingly, Dauser et al calculated that the higher procedure-related costs of robotic-assisted techniques were balanced by a shorter hospital stay and a lower 30-days readmission rate compared to open hernia surgery [ 38 ]. Baur and colleagues described a reduction of case costs compared to the IPOM technique basically due to cheaper meshes [ 39 ]. This study also shows a significant longer operating time for RAHR in comparison to open sublay and eMILOS techniques.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

Plitzko,

Stüben,

Giannou

et al. 2023

Langenbecks Arch Surg

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Purpose With robotic surgical devices, an innovative tool has stepped into the arena of minimally invasive hernia surgery. It combines the advantages of open (low recurrence rates and ability to perform complex procedure such as transverse abdominis release) and laparoscopic surgery (low rate of wound and mesh infections, less pain). However, a superiority to standard minimally invasive procedures has not yet been proven. We present our first experiences of robotic mesh repair of incisional hernias and a comparison of our results with open and minimally invasive sublay techniques. Methods A retrospective analysis of all patients who underwent robotic-assisted mesh repair (RAHR) for incisional hernia between April and November 2022 (RAHR group) and patients who underwent open sublay (Sublay group) or eMILOS hernia repair (eMILOS group) between January 2018 and November 2022 was carried out. Patients in the RAHR group were matched 1:2 to patients in the Sublay group by propensity score matching. Patient demographics, preoperative hernia characteristics and cause of hernia, intraoperative variables, and postoperative outcomes were evaluated. Furthermore, a subgroup analysis of only midline hernia was performed. Results A total of 21 patients received robotic-assisted incisional hernia repair. Procedures performed included robotic retro-muscular hernia repair (r-RMHR, 76%), with transverse abdominis release in 56% of the cases. In one patient, r-RHMR was combined with robotic inguinal hernia repair. Two patients (10%) were operated with total extraperitoneal technique (eTEP). Robotic-assisted transabdominal preperitoneal hernia repair (r-TAPP) was performed in three patients (14%). Median (range) operating time in the RAHR group was significantly longer than in the sublay and eMILOS group (291 (122–311) vs. 109.5 (48–270) min vs. 123 (100–192) min, respectively, p < 0.001). The meshes applied in the RAHR group were significantly compared to the sublay (mean (SD) 529 ± 311 cm2 vs. 356 ± 231, p = 0.037), but without a difference compared to the eMILOS group (mean (SD) 596 ± 266 cm2). Median (range) length of hospital stay in the RAHR group was significantly shorter compared to the Sublay group (3 (2–7) vs. 5 (1–9) days, p = 0.032), but not significantly different to the eMILOS group. In short term follow-up, no hernia recurrence was observed in the RAHR and eMILOS group, with 9% in the Sublay group. The subgroup analysis of midline hernia revealed very similar results. Conclusion Our data show a promising outcome after robotic-assisted incisional hernia repair, but no superiority compared to the eMILOS technique. However, RAHR is a promising technique especially for complex hernia in patients with relevant risk factors, especially immunosuppression. Longer follow-up times are needed to accurately assess recurrence rates, and large prospective trials are needed to show superiority of robotic compared to standard open and minimally invasive hernia repair.

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Section: Discussionmentioning

confidence: 99%

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

Plitzko,

Stüben,

Giannou

et al. 2023

Langenbecks Arch Surg

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“…Robotic‐assisted retrorectus repair was reported by Abdalla et al for extraperitoneal access in 2012, 18 Warren et al for transabdominal access in 2017, 19 and Belyansky et al for eTEP access in 2018 20 . Robotic transabdominal single‐docking approach has been performed for 3.4–7 cm defect wide 21–24 …”

Section: Discussionmentioning

confidence: 99%

“…20 Robotic transabdominal singledocking approach has been performed for 3.4-7 cm defect wide. [21][22][23][24] The advantages of the robotic approach include the ease of the extensive myofascial dissection, suture manipulation, and the greatly improved ergonomics, especially during the suturing of the "roof of the abdomen." In addition, robotic approach is reported to cause significantly less intestinal injury than laparoscopic surgery.…”

Section: Robotic-assisted Retrorectus Repairmentioning

confidence: 99%

The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan

Shimada

Matsubara

Sanbonmatsu

et al. 2022

Asian J Endoscop Surgery

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Extraperitoneal mesh repair for ventral hernia has garnered attention and its rate has been increasing due to concerns for the potential complications of intraperitoneal mesh repair. Recently, robotic-assisted ventral hernia repair is highlighted as a solution to the technically demanding nature of laparoscopic transabdominal or enhanced-view totally extraperitoneal retrorectus ventral hernia repair. A 78-year-old man, who had undergone robot-assisted radical prostatectomy 10 months earlier, presented with an incisional hernia of European Hernia Society Classification M3W2, length 4 cm, width 5 cm with rectus diastasis. A right single-docking robotic-assisted transabdominal retrorectus repair was performed using a 21 by 14 cm self-gripping mesh and anterior wall reconstruction was done by 0 barbed nonabsorbable running suture.There were no complications and recurrence observed during a 7 months postoperative period. Single-docking robotic-assisted transabdominal retrorectus repair was considered a good option for midline moderate-size incisional hernias from the point of view of the ease of suturing, adequateness of dissection and prevention of bowel injury.

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“…A meta-analysis that included nine RCTs showed that both open and laparoscopic techniques of IH have similar rates of reoperation and surgical complications and comparable recurrence rates [48]. Recent case series have proved the feasibility of the robotic approach to IH repair with comparable results with laparoscopic surgery [64][65][66]. However, a tangible clinical benefit does not offset the robotic approach's higher cost and longer operative time [67].…”

Section: Surgical Techniques and Postoperative Carementioning

confidence: 99%

Incisional Hernia: A Surgical Complication or Medical Disease?

Omar,

Zaimis,

Townsend

et al. 2023

Cureus

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Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.

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Robotic hernia repair II. English version

Cited by 10 publications

References 27 publications

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

Robotic-assisted repair of incisional hernia—early experiences of a university robotic hernia program and comparison with open and minimally invasive sublay technique (eMILOS)

The first case of robotic‐assisted transabdominal retrorectus repair for incisional hernia in Japan

Incisional Hernia: A Surgical Complication or Medical Disease?

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