Robotic versus open transversus abdominis release and incisional hernia repair: A case-control study

Reeves, Jenna M.; Mehta, Saurabh; Prabha, Ramesh Damodaran; Salama, Yasser; Mittal, Anubhav

doi:10.1016/j.lers.2020.06.002

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…No heterogeneity was found (I2 = 12.5%, p = 0.63). Similarly, the rate of reoperation, explored by 5 studies [8][9][10][11]13] and 717 patients, was not significantly different between rTAR and oTAR (4% vs 6.5%, OR 0.636, 95% CI 0.29-1.398, p = 0.26) (Fig. 3I).…”

Section: Readmission and Reoperationmentioning

confidence: 76%

“…After the screening of title and abstract and removal of duplicates, 17 articles were selected for further review. After exclusion of 11 articles based on exclusion criteria, 6 studies were included in the meta-analysis [8][9][10][11][12][13].…”

Section: Resultsmentioning

confidence: 99%

“…However, when we evaluated the rate of SSOPI (five studies [8][9][10][11]13] on 717 subjects), no differences were noted between rTAR and oTAR (5 vs 8.9%, OR 0.592, 95% CI 0.293-1.198, p = 0.11) (Fig. 3D).…”

Section: Surgical Site Occurrencementioning

confidence: 96%

“…All studies but one [9][10][11][12][13], reported the rate of systemic complications after surgery (451 patients). The overall rate was 20.2%.…”

Section: Systemic Complicationsmentioning

confidence: 99%

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Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis

Bracale

Corcione

Neola

et al. 2021

Hernia

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Purpose To compare early postoperative outcomes after transversus abdominis release (TAR) for ventral hernia repair with open (oTAR) and robotic (rTAR) approach. Methods A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Web of Science databases was conducted to identify comparative studies until October 2020. A meta-analysis of postoperative short-term outcomes was performed including complications rate, operative time, length of stay, surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring intervention (SSOPI), systemic complications, readmission, and reoperation rates as measure outcomes. Results Six retrospective studies were included in the analysis with a total of 831 patients who underwent rTAR (n = 237) and oTAR (n = 594). Robotic TAR was associated with lower risk of complications rate (9.3 vs 20.7%, OR 0.358, 95% CI 0.218–0.589, p < 0.001), lower risk of developing SSO (5.3 vs 11.5%, OR 0.669, 95% CI 0.307–1.458, p = 0.02), lower risk of developing systemic complications (6.3 vs 26.5%, OR 0.208, 95% CI 0.100–0.433, p < 0.001), shorter hospital stay (SMD − 4.409, 95% CI − 6.000 to − 2.818, p < 0.001) but longer operative time (SMD 53.115, 95% CI 30.236–75.993, p < 0.01) compared with oTAR. There was no statistically significant difference in terms of SSI, SSOPI, readmission, and reoperation rates. Conclusion Robotic TAR improves recovery by adding the benefits of minimally invasive procedures when compared to open surgery. Although postoperative complications appear to decrease with a robotic approach, further studies are needed to support the real long-term and cost-effective advantages.

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Section: Readmission and Reoperationmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Surgical Site Occurrencementioning

confidence: 96%

“…All studies but one [9][10][11][12][13], reported the rate of systemic complications after surgery (451 patients). The overall rate was 20.2%.…”

Section: Systemic Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis

Bracale

Corcione

Neola

et al. 2021

Hernia

View full text Add to dashboard Cite

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“…Eleven studies 12–14 , 23–25 , 27 , 29 , 30 , 36 , 39 used data from prospectively maintained databases, nine 12 , 13 , 24 , 25 , 27 , 32 , 34–36 compared robotic VHR with open repair ( Table 3 ), and 15 13 , 14 , 22 , 23 , 26 , 28–31 , 33 , 36–40 compared robotic surgery with laparoscopy. All observational studies were performed in the USA, except for two studies 27 , 35 from Austria and Australia. Ten studies 12–14 , 23 , 25 , 29 , 30 , 32 , 35 , 38 were multi-institutional, 11 22 , 24 , 26–28 , 31 , 33 , 34 , 37 , 39 , 40 were from a single institution, and one study 36 did not specify the number of centres.…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes and cost of robotic ventral hernia repair: systematic review

Childers

Virgilio

et al. 2021

BJS Open

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Background Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. Methods This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to ‘robot-assisted’, ‘cost effectiveness’, and ‘ventral hernia’ or ‘incisional hernia’ from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. Results Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. Conclusion Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.

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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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Robotic versus open transversus abdominis release and incisional hernia repair: A case-control study

Cited by 10 publications

References 18 publications

Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis

Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis

Clinical outcomes and cost of robotic ventral hernia repair: systematic review

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

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