Robotic TAPP Ventral Hernia Repair: Early Lessons Learned at an Inner City Safety Net Hospital

Abstract

Background and Objectives:Ventral hernia repair is one of the most commonly performed general surgery procedures, and minimally invasive approaches are increasingly preferred. The physiologic repair offered by the preperitoneal approach is favorable, with reduced complications, but it remains a technical challenge. The robotic platform allows for enhanced instrument flexibility and ease of operation. We conducted a retrospective review of our experience with robotic transabdominal preperitoneal repair (rTAPP) versus robotic intraperitoneal onlay mesh (rIPOM) at a tertiary care hospital in an urban setting.Methods:We reviewed the records of patients undergoing minimally invasive ventral hernia repair from March 2014 through March 2017. Demographics, complication rates, and operative time were compared by t test and Chi square test, as applicable.Results:Sixty-three patients met the criteria for inclusion in the study. Of those, 27 underwent ventral hernia repair with rIPOM and 36 with rTAPP, with no major intraoperative complications. There were no significant differences in demographics between the 2 groups in age, BMI, and sex. The difference in mean operative time was not significant (rIPOM 167.26 [SD 51.76] minutes vs rTAPP 158.84 minutes [SD 61.5]; P = .57), whereas mean console time was significantly different (rIPOM 70.88 minutes [SD 32.88] vs rTAPP 90.26 [SD 31.17]; P = .018). Postoperative complications occurred only with rIPOM and included urinary retention, seroma, and fever.Conclusions:rTAPP is a promising alternative to rIPOM, with reduced complications without adding significant operative time, and may allow for reduced costs.

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)): Part B

“…Finally, Kennedy et al compared 27 rIPOM to 36 rTAPP patients. Operative time was similar between groups, as were minor perioperative complications [37]. No inferences can be drawn regarding hernia recurrence due to lack of longterm follow-up.…”

Intraperitoneal versus extraperitoneal mesh in minimally invasive ventral hernia repair: a systematic review and meta-analysis

“…In a total of 11 studies with 2320 patients, 1353 patients who underwent minimally invasive VHR with intraperitoneal mesh placement and 967 patients who underwent minimally invasive VHR with extraperitoneal mesh placement were included in the qualitative synthesis and quantitative synthesis (Fig. 1) [10,11,[14][15][16][17][18][19][20][21][22]. All patients had similar baseline characteristics (Table 1).…”

“…A total 8 studies (866 patients) reported readmission rates (Fig. 2d) [14,15,[17][18][19][20][21][22]. A total of 1 study reported that patients in both groups were not readmitted during the course of follow-up and were therefore excluded from the analysis.…”

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

“…Within EG group, 58% of participants reported that their previous gaming activities shortened their laparoscopic skills, which did not show statistical significance and the literature also has conflicting data when stating that video games shorten the curve. The biggest gain seems to be related to the psychomotor component [18][19][20][21] . It is known that the resting period is important for the retention of psychomotor skills as stated 22 .…”