The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it?

Belyansky, Igor; Weltz, Adam S.; Sibia, Udai S.; Turcotte, Justin; Taylor, Haley; Zahiri, H. Reza; Turner, Timothy R.; Park, Adrian

doi:10.1007/s00464-017-5850-0

Cited by 22 publications

(4 citation statements)

References 16 publications

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“…8 A recent study demonstrated that minimally invasive AWR had a significantly decreased length of stay compared with open AWR. 9 In addition, robotic retromuscular ventral hernia repair was shown to be associated with decreased length of stay (LOS) compared with open repair 10 and robotic TAR was associated with decreased wound complication rates, morbidity, and LOS compared with open repair. 10–12 This report describes the early experience and short-term outcomes of robotic TAR and r-AWR for repair of complex ventral hernias performed by a single surgeon.…”

Section: Introductionmentioning

confidence: 99%

Ascending the Learning Curve of Robotic Abdominal Wall Reconstruction

Halpern

Howell

Boinpally

et al. 2019

JSLS

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Background: Robotic complex abdominal wall reconstruction (r-AWR) using transversus abdominis release (TAR) is associated with decreased wound complications, morbidity, and length of stay compared with open repair. This report describes a single-institution experience of r-AWR. Methods: A retrospective chart review was performed on patients who underwent r-AWR by a single surgeon (D.H.) from August 2015 through October 2018. Results: Fifty-five patients underwent r-AWR (16 males [29%] and 39 females [71%]) with a mean age of 60.2 (range 33 to 87) years and a mean body mass index of 34.6 (range 23 to 54) kg/m 2 . Forty-one patients presented with an initial ventral hernia (74.5%) and 14 with a recurrent hernia (25.5%). Five patients had a grade 1 hernia (9.1%), 46 had a grade 2 hernia (83.6%), and 4 had a grade 3 hernia (7.3%) according to the Ventral Hernia Working Group system. Thirty-four (62%) patients underwent TAR, 21 (38%) patients underwent bilateral retrorectus release, and 10 (18.2%) patients underwent concomitant inguinal hernia repair. Mean operative time with TAR was 294 (range 106 to 472) minutes and 183 (range 126 to 254) minutes without TAR. Mean length of stay was 1.5 (range 0 to 10) days. Mean follow-up was 10.7 (range 1 to 52) weeks with no hernia recurrences. Seromas occurred in 6 (10.9%) patients, with 2 (3.6%) requiring drainage. Two (3.6%) 30-day readmissions occurred with no conversions to open or 30-day mortalities. Conclusions: r-AWR with and without TAR is a safe and feasible procedure associated with a short LOS, low complication rate, and low recurrence even within the surgeon's learning curve experience.

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Section: Introductionmentioning

confidence: 99%

Ascending the Learning Curve of Robotic Abdominal Wall Reconstruction

Halpern

Howell

Boinpally

et al. 2019

JSLS

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“…In comparison to other literature for abdominal wall reconstruction, overall the number of days was increased in both groups. Other institutions have also noted decreased hospital stay length, although approximately 1–2 days for robotic repairs and up to 5 days for open repairs 2 , 6 , 8 , 10 . At our institution, those receiving open approaches are routinely given an epidural and pump-controlled analgesia (PCA), which may contribute to a longer hospital stay due to pain control weaning parameters and pain management expectations.…”

Section: Discussionmentioning

confidence: 97%

“…Cost analysis would also be a crucial element to investigate in future studies. Belyansky suggested the additional operating time was more than offset by the reduction in hospital days, with overall costs for minimally invasive group being almost half of the open repair 2 . While operating times contribute heavily to costs, whether this outweighs the difference in hospital days could argue for one approach over the other.…”

Section: Discussionmentioning

confidence: 99%

“…Robotic assisted laparoscopic surgery arguably provides the visualization and mobilization of tissues for component separation of open repair with the benefits of minimally invasive approach, with comparable outcomes. Recent literature of utilizing this approach at other institutions have demonstrated shorter length of stays, although longer operative times 2 , 6 – 8 .…”

Section: Introductionmentioning

confidence: 99%

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Comparisons of abdominal wall reconstruction for ventral hernia repairs, open versus robotic

Nguyen

Baldry

Shiozaki

et al. 2021

Sci Rep

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The surgical complexities of our current population have pushed the technological limits of healthcare, urging for minimally invasive approaches. For ventral hernias, in particular, robotic assisted laparoscopic repairs have been met with conflict. Cost and longer operative times are among the arguments against robotic surgery, although thorough evaluation of patient outcomes could potentially advocate for use of this tool. We attempted to approach this by retrospectively reviewing our own data. We reviewed charts between September 2016 and February 2017 of patients receiving complex hernia repairs, either a standard open repair (SOR) or robotic-assisted repair (RAR). Data collected included preoperative, perioperative, and postoperative care. Of the 43 patients reviewed, 16 were SOR, versus 27 RAR. Patients were comparable in age, gender, BMI, diabetes as a comorbidity; average hernia defect size was similar between the two groups. Although operative times were longer in the RAR group, estimated blood loss (EBL) was less. Hospital stay was also shorter in the RAR group, at 3.0 ± 1.9 days versus 9.6 ± 8.4 days for the OAR group. Of those requiring critical care management, only one patient had a robotic assisted repair, versus half of the patients who received an open repair. Of the patients who presented to the emergency department within 30 days of surgery, each group had four patients, and two from the OAR group required admission. Our data is consistent with other literature supporting shorter lengths of stays. Although the robotic approach did required a longer operative time, the resulting improved patient outcomes support this technique for complex ventral hernia repairs.

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