|
1
|
Celotto F, Ramacciotti N, Danieli G, Pinto F, Spolverato G, Morelli L, Bianco FM. Learning Curve for Robotic Inguinal Hernia Repair With da Vinci Single-Port Robotic System. Surg Innov 2025; 32:253-261. [PMID: 39865449 DOI: 10.1177/15533506251314605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
BackgroundTransabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times.MethodsThe operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed.ResultsThe DT has remained constant over time (P > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; P = 0.08). In FCT and CT, 3 phases were identified in which times remained stable (P > 0.9 and P = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; P = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding.ConclusionsThe learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.
Collapse
Affiliation(s)
- Francesco Celotto
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Niccolò Ramacciotti
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Giacomo Danieli
- Unit of Biostatistics, Epidemiology and Public Health (UBEP), Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Federico Pinto
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Luca Morelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Francesco Maria Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
|
2
|
Lorenz WR, Holland AM, Adams AS, Mead BS, Scarola GT, Kercher KW, Augenstein VA, Heniford BT. Open versus laparoscopic versus robotic inguinal hernia repair: A propensity-matched outcome analysis. Surgery 2025; 179:108895. [PMID: 39472265 DOI: 10.1016/j.surg.2024.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/19/2024] [Accepted: 08/13/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Inguinal hernia repair is one of the most common surgical procedures in the world. Each repair technique, open, laparoscopic, and robotic, has its advantages and advocates. Prior studies have compared 2 techniques, but there are little data comparing all 3 approaches with long-term follow-up. METHODS Prospectively collected data for unilateral inguinal hernia repair between 2007 and 2022 were reviewed. Using more than 3,300 inguinal hernia repairs, a 1:1:1 propensity score match was performed for open inguinal hernia repair, laparoscopic inguinal hernia repair, and robotic inguinal hernia repair based on patient age, sex, body mass index, and laterality. Standard descriptive and comparative statistics were performed. Data below is reported consistently as open inguinal hernia repair versus laparoscopic inguinal hernia repair versus robotic inguinal hernia repair. RESULTS A total of 420 patients were matched, with 140 in each group. There was no difference in age, body mass index, or smoking status between groups. Open inguinal hernia repair had significantly more comorbidities (2.8 vs 2.6 vs 2.3; P = .035), including higher rates of chronic obstructive pulmonary disease (5.0% vs 0.0% vs 1.4%; P = .013), cirrhosis (4.3% vs 0.0% vs 1.4%; P = .032), and congestive heart failure (5.0% vs 0.7% vs 0.7%; P = .023). American Society of Anesthesiologists scores differed significantly between groups (stage III and IV: 35.0% vs 20.0% vs 28.6%; P = .004). Open inguinal hernia repair were more often recurrent (48.6% vs 27.9% vs 17.1%; P < .001). The mean operative time was significantly different between groups (88.0 vs 86.1 vs 101.4 minutes; P < .001). There was no difference in wound infection (0.7% vs 0.0% vs 0.0%; P > .99), hematoma (1.4% vs 0.7% vs 1.4%; P > .99), seroma requiring intervention (2.9% vs 0.7% vs 0.7%; P = .377), or readmission (0.0% vs 2.1% vs 1.4%; P = .378). The rate of prolonged discomfort, requiring more than 2 pain medication refills, was similar between groups (2.9% vs 2.1% vs 2.1%; P = .903). Robotic inguinal hernia repair was significantly more expensive than laparoscopic inguinal hernia repair and open inguinal hernia repair ($10,005 ± $7,050 vs $17,155 ± $6,702 vs $31,173 ± $8,474; P < .001). With follow-up of at least 2.4 years in each group (3.6 vs 4.8 vs 2.4 years; P < .001), the recurrence rate was comparable (3.6% vs 0.7% vs 0.7%; P = .226). CONCLUSIONS All techniques are safe and effective in qualified hands. Open inguinal hernia repair was more commonly used in comorbid patients and recurrent hernias, but the techniques had comparable rates of wound complications, postoperative prolonged discomfort, and recurrence.
Collapse
Affiliation(s)
- William R Lorenz
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/WLorenzjr
| | - Alexis M Holland
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/AlexisHollandMD
| | - Alexandrea S Adams
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Brittany S Mead
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - Gregory T Scarola
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/GregoryTScarola
| | - Kent W Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC. https://twitter.com/KentKercher
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC.
| |
Collapse
|
|
3
|
Huerta S, Garza AM. A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century. J Clin Med 2025; 14:990. [PMID: 39941661 PMCID: PMC11818799 DOI: 10.3390/jcm14030990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 01/28/2025] [Accepted: 02/03/2025] [Indexed: 02/16/2025] Open
Abstract
Background: In the 21st century, the management of groin hernias (GHs) has evolved from watchful waiting (WW) to robotic hernia repair (RHR). The present study interrogates the status of robotics in the context of current repairs and provides one author's perspectives. Methods: A systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies comparing open (OHR) to robotic hernia repair (RHR); RHR to laparoscopic hernia repair (LHR); or OHR vs. LHR vs. RHR. The historical context was extracted from previous reviews. Results: Fifty-four studies were included in the analysis. Three techniques have withstood the test of time: OHR (tissue and mesh repairs), laparo-endoscopic (TEP and TAPP), and RHR. The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this technique. While the number of overall complications with RHR is similar to OHR, in a minority of cases, complications are more consequential with the robotic platform. Conclusions: RHR has emerged as an unequivocally powerful technique for the management of GHs. OHR remains the technique of choice for local/regional anesthesia, posterior recurrences, and in centers that lack other platforms. In low- and middle-income countries, OHR is the most utilized technique. Centers of excellence should offer all techniques of repair including WW.
Collapse
Affiliation(s)
- Sergio Huerta
- VA North Texas Health Care System, Dallas, TX 75216, USA
| | - Amanda M. Garza
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| |
Collapse
|
|
4
|
Gantner L, Mignot H, Pochhammer J, Grieder F, Breitenstein S. Robotic minimally invasive inguinal hernia repair with the Dexter robotic system™: A prospective multicenter clinical investigation. Surg Endosc 2024; 38:7647-7655. [PMID: 39542890 PMCID: PMC11615000 DOI: 10.1007/s00464-024-11361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 10/11/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) has been established with various robotic platforms. The Dexter robotic system is an open platform consisting of a sterile surgeon's console, two robotic instrument arms, and one robotic endoscope arm. This study aimed to confirm the perioperative and early postoperative safety and clinical performance of the Dexter system in patients undergoing primary transperitoneal inguinal hernia repair. METHODS The primary objectives of this multicenter study conducted at three centers in France, Germany, and Switzerland were to document the successful completion of rTAPP procedures and the occurrence of serious adverse events (Clavien-Dindo grades III-V), device-related events up to 30 days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems. RESULTS 50 patients with a median age of 62.5 years (IQR 51.0-72.0) and BMI of 25.1 kg/cm2 (IQR 23.5-28.7), respectively, underwent inguinal hernia repair (33 unilateral, 17 bilateral). All surgeries were successfully completed using three standard laparoscopy trocars. There were no conversions to open surgery, intraoperative complications or device deficiencies. The median skin-to-skin operative time was 50 min (IQR 45-60) for unilateral hernias and 96 min (IQR 84-105) for bilateral hernias. The median console time was 30 min (IQR 26-41) for unilateral and 66 min (IQR 60-77) for bilateral hernias. Twenty-six patients were discharged on the day of surgery, and 22 on postoperative day 1. CONCLUSION This study confirmed the use of the Dexter system in rTAPP was feasible and safe in multicenter cohorts, with operative times consistent with the literature on other robotic platforms. Our data demonstrated the accessibility of this new robotic approach, even when adopted by surgeons new to robotics. The Dexter system emerged as a valuable device in the hernia repair toolkit for both experienced robotic surgeons and those new to the field.
Collapse
Affiliation(s)
- Lukas Gantner
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
| | - Hubert Mignot
- Department of General Surgery, Centre Hospitalier de Saintes, Saintes, France
| | - Julius Pochhammer
- Clinic for General, Visceral, Thoracic, Transplant and Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Felix Grieder
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| |
Collapse
|
|
5
|
Aiolfi A, Bona D, Calì M, Manara M, Bonitta G, Cavalli M, Bruni PG, Carmignani L, Danelli P, Bonavina L, Köckerling F, Campanelli G. Is previous radical prostatectomy a contraindication to minimally invasive inguinal hernia repair? A contemporary meta-analysis. Hernia 2024; 28:1525-1536. [PMID: 38990229 DOI: 10.1007/s10029-024-03098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Traditionally, radical prostatectomy (RP) has been considered a contraindication to minimally invasive inguinal hernia repair. Purpose of this systematic review was to examine the current evidence and outcomes of minimally invasive inguinal hernia repair after RP. MATERIALS AND METHODS Web of Science, PubMed, and EMBASE data sets were consulted. Laparoscopic transabdominal preperitoneal repair (TAPP), robotic TAPP (r-TAPP), and totally extraperitoneal (TEP) repair were included. RESULTS Overall, 4655 patients (16 studies) undergoing TAPP, r-TAPP, and TEP inguinal hernia repair after RP were included. The age of the patients ranged from 35 to 85 years. Open (49.1%), laparoscopic (7.4%), and robotic (43.5%) RP were described. Primary unilateral hernia repair was detailed in 96.3% of patients while 2.8% of patients were operated for recurrence. The pooled prevalence of intraoperative complication was 0.7% (95% CI 0.2-3.4%). Bladder injury and epigastric vessels bleeding were reported. The pooled prevalence of conversion to open was 0.8% (95% CI 0.3-1.7%). The estimated pooled prevalence of seroma, hematoma, and surgical site infection was 3.2% (95% CI 1.9-5.9%), 1.7% (95% CI 0.9-3.1%), and 0.3% (95% CI = 0.1-0.9%), respectively. The median follow-up was 18 months (range 8-48). The pooled prevalence of hernia recurrence and chronic pain were 1.1% (95% CI 0.1-3.1%) and 1.9% (95% CI 0.9-4.1%), respectively. CONCLUSIONS Minimally invasive inguinal hernia repair seems feasible, safe, and effective for the treatment of inguinal hernia after RP. Prostatectomy should not be necessarily considered a contraindication to minimally invasive inguinal hernia repair.
Collapse
Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy.
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Matteo Calì
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Michele Manara
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Via C. Belgioioso, 173, Milan, Italy
| | - Marta Cavalli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Piero Giovanni Bruni
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Luca Carmignani
- Division of Urology, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piergiorgio Danelli
- Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L. Sacco University Hospital, 20157, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy
| | - Ferdinand Köckerling
- Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité University Medicine, Am Nordgraben 2, 13509, Berlin, Germany
| | - Giampiero Campanelli
- Division of General Surgery, Department of Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Milan, Italy
| |
Collapse
|
|
6
|
Hinojosa-Ramirez F, Tallon-Aguilar L, Tinoco-Gonzalez J, Sanchez-Arteaga A, Aguilar-Del Castillo F, Alarcon-Del Agua I, Morales-Conde S. Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system? Hernia 2024; 28:1205-1214. [PMID: 38503978 PMCID: PMC11297114 DOI: 10.1007/s10029-024-03006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). MATERIALS AND METHODS A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. RESULTS A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. CONCLUSIONS The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.
Collapse
Affiliation(s)
- F Hinojosa-Ramirez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - L Tallon-Aguilar
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain.
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain.
| | - J Tinoco-Gonzalez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain
| | - A Sanchez-Arteaga
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - F Aguilar-Del Castillo
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - I Alarcon-Del Agua
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - S Morales-Conde
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain
| |
Collapse
|
|
7
|
Reddy S, Tote D, Zade A, Sudabattula K, Dahmiwal T, Hatewar A, Bawiskar D. Comparative Analysis of Robotic-Assisted Versus Laparoscopic Appendectomy: A Review. Cureus 2024; 16:e63488. [PMID: 39081431 PMCID: PMC11288292 DOI: 10.7759/cureus.63488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/29/2024] [Indexed: 08/02/2024] Open
Abstract
Appendectomy ranks among the most common surgical procedures. Laparoscopic appendectomy has become increasingly popular among certain surgeons. Even laparoscopic appendectomy is considered the gold standard; many surgical subspecialties have adopted robotic surgery in the past 10 years. The robotic system is recognized for enhancing stability, visualization, precision, and spatial flexibility. Surgeons can operate with enhanced dexterity, reduced tremors, three-dimensional visualization, up to 10 times magnification, and control over four arms thanks to improved ergonomics that allow them to sit at a customizable console. The purpose of this study is to evaluate and compare the overall effects, such as intraoperative time, postoperative recovery, feasibility for surgeons, and cost-effectiveness, of robotic-assisted appendectomy and laparoscopic appendectomy through the available literature. It was found that both robotic and laparoscopic surgeries work well for appendectomy, but in some studies, it was found that robotic surgery comes with the perks of shorter hospital stays and quicker recovery, even though it is more expensive, and in some studies, no differences were observed in patient recovery postoperatively. Laparoscopic surgery is still a highly effective and commonly used method, with proven advantages over open appendectomy, despite taking longer for the procedure. We need more studies to fully understand the advantages and disadvantages of robotic surgery, especially when it comes to cost-effectiveness and wider health outcomes.
Collapse
Affiliation(s)
- Srinivasa Reddy
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Darshana Tote
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anup Zade
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kesav Sudabattula
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Dahmiwal
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akansha Hatewar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dushyant Bawiskar
- Sports Medicine, Abhinav Bindra Targeting Performance, Bangalore, IND
| |
Collapse
|
|
8
|
Jung S, Lee HS. Robotic transabdominal preperitoneal repair for bilateral obturator hernia: a video vignette. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:40-43. [PMID: 38494185 PMCID: PMC10961231 DOI: 10.7602/jmis.2024.27.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 03/19/2024]
Abstract
Obturator hernias (OHs) are a rare cause of bowel obstruction that requires immediate surgical intervention to prevent morbidity and mortality. Patients with OHs present with acute intestinal obstruction secondary to incarceration, with a high morbidity and mortality rate due to delayed diagnosis and treatment. Although several surgical approaches have been reported, a standard approach for OH treatment has not yet been established. Here, we report the case of a 74-year-old woman who presented with bilateral OHs. The patient presented at our institution with pain in the left lower quadrant. Computed tomography revealed preperitoneal fat in both obturator foramen. Robotic transabdominal preperitoneal (R-TAPP) bilateral OH repair was performed, and a mesh was placed over both obturator foramen. The patient recovered without postoperative complications and was discharged on postoperative day 2. This suggests that the R-TAPP approach is safe for OH repair without incarceration.
Collapse
Affiliation(s)
- Sungwoo Jung
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyung Soon Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
|
9
|
Li X, Li YJ, Dong H, Wang DC, Wei J. Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia. PLoS One 2024; 19:e0298989. [PMID: 38408054 PMCID: PMC10896538 DOI: 10.1371/journal.pone.0298989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Inguinal hernia is a common global disease. This study aims to investigate the effectiveness and safety of robot-assisted transabdominal preperitoneal repair (RTAPP) and laparoscopic transabdominal preperitoneal repair (LTAPP) for inguinal hernia. METHODS We conducted a thorough search in Cochrane Library, Embase, and PubMed for relevant clinical studies. After applying inclusion and exclusion criteria, the quality of selected studies was assessed using the Jadad scale for randomized controlled studies and the Newcastle-Ottawa scale for observational studies. Meta-analysis was performed using RevMan 5.3 software. RESULTS A total of ten studies were included, comprising two randomized controlled studies and eight non-randomized controlled studies. Meta-analysis results revealed no statistically significant differences between the RTAPP group and the LTAPP group regarding hospital stay [MD = 0.21 days, 95% CI (-0.09, 0.51), P = 0.17], incidence of seroma [OR = 0.85, 95% CI(0.45, 1.59), P = 0.61], overall complication rate [OR = 1.22, 95% CI(0.68, 2.18), P = 0.51], readmission rate [OR = 1.31, 95% CI(0.23, 7.47), P = 0.76], and recurrence rate [OR = 0.82, 95% CI(0.22, 3.07), P = 0.77]. However, the RTAPP group had longer operation time compared to the LTAPP group [MD = 14.02 minutes, 95% CI (6.65, 21.39), P = 0.0002], and the cost of the RTAPP procedure was higher than that of the LTAPP procedure [MD = $4.17 thousand, 95% CI (2.59, 5.76), P<0.00001]. CONCLUSION RTAPP for inguinal hernia is a safe and feasible approach, however, it is associated with increased operation time and treatment costs.
Collapse
Affiliation(s)
- Xi Li
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Yue-Juan Li
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Hui Dong
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| | - Jian Wei
- Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan, China
| |
Collapse
|
|
10
|
de'Angelis N, Schena CA, Moszkowicz D, Kuperas C, Fara R, Gaujoux S, Gillion JF, Gronnier C, Loriau J, Mathonnet M, Oberlin O, Perez M, Renard Y, Romain B, Passot G, Pessaux P. Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis. Surg Endosc 2024; 38:24-46. [PMID: 37985490 DOI: 10.1007/s00464-023-10545-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/13/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. METHODS PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. RESULTS Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95 mL), shorter LOS (- 3.4 day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. CONCLUSION These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.
Collapse
Affiliation(s)
- Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
- Faculty of Medicine, University of Paris Cité, Paris, France.
| | - Carlo Alberto Schena
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
| | - David Moszkowicz
- Service de Chirurgie Générale et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
| | | | - Régis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | | | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Jérôme Loriau
- Department of Digestive Surgery, St-Joseph Hospital, Paris, France
| | - Muriel Mathonnet
- Department of General, Endocrine and Digestive Surgery, University Hospital of Limoges, Limoges, France
| | - Olivier Oberlin
- Service de Chirurgie, Groupe Hospitalier Privé Ambroise-Paré - Hartmann, Paris, France
| | - Manuela Perez
- Département de chirurgie viscérale, métabolique et cancérologie (CVMC), CHRU de Nancy-hôpitaux de Brabois, Vandœuvre-lès-Nancy, France
| | - Yohann Renard
- Departement of General Surgery, Reims Champagne-Ardenne University, Reims, France
| | - Benoît Romain
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Guillaume Passot
- Department of Surgical Oncology, Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Patrick Pessaux
- Visceral and Digestive Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France
| |
Collapse
|
|
11
|
Okamoto N, Misawa T, Shimada G, Saito T, Takiguchi S, Imamura K, Ohuchi M, Tanida T, Watanobe I, Fujii T, Takemasa I, Mizutani F, Matsubara T, Hayakawa S, Watanabe T, Okuya K, Takahashi H, Horikawa M, Wakabayashi G. Safety and short-term outcomes of robotic-assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study. Asian J Endosc Surg 2024; 17:e13251. [PMID: 37858296 DOI: 10.1111/ases.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION We aimed to evaluate the safety and short-term outcomes of robotic-assisted transabdominal preperitoneal repair for inguinal hernia in 12 pioneering hospitals in Japan. METHODS Clinical data of patients who underwent robotic-assisted transabdominal preperitoneal repair between September 1, 2016, and December 31, 2021 were collected. Primary outcome measures were intra-operative adverse events and post-operative complications, whereas secondary outcomes were surgical outcomes, including chronic pain, recurrence, and learning curve. RESULTS In total, 307 patients were included. One case of inferior epigastric arterial injury was reported; no cases of bowel or bladder injury were reported. Thirty-five seromas were observed, including four (1.3%) cases that required aspiration. The median operative time of a unilateral case was 108 minutes (interquartile range: 89.8-125.5), and post-operative pain was rated 1 (interquartile range: 0-2) on the numerical rating scale. In complicated cases, such as recurrent inguinal hernias and robotic-assisted radical prostatectomy-associated hernias, dissection and suture were safely achieved, and no complications were observed, except for non-symptomatic seroma. All patients underwent robotic procedures, and there was no chronic post-operative inguinal pain, although one case of hernia recurrence was reported. Regarding the learning curve, plateau performance was achieved after 7-10 cases in terms of operative time (P < .001). CONCLUSION Robotic-assisted transabdominal preperitoneal repair can be safely introduced in Japan. Regardless of the involvement of many surgeons, the mastery of robotic techniques was achieved relatively quickly. The advantage of robotic technology such as wristed instruments may expand the application of minimally invasive hernia repair for complicated cases.
Collapse
Affiliation(s)
- Nobuhiko Okamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Takeyuki Misawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Gen Shimada
- Hernia Center, St. Luke's International Hospital, Tokyo, Japan
| | - Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kiyotaka Imamura
- Department of Surgery, Teine Keijinkai Medical Center, Sapporo, Japan
| | - Masakazu Ohuchi
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Tsukasa Tanida
- Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Ikuo Watanobe
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | | | | | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toru Watanabe
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Hideki Takahashi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masahiro Horikawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| |
Collapse
|
|
12
|
Cheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg 2023; 109:4221-4237. [PMID: 37988410 PMCID: PMC10720873 DOI: 10.1097/js9.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.
Collapse
Affiliation(s)
- Xi Cheng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqing Jia
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Guo
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuiyu Xu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haosheng Li
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaodong Wang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqi Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
|
13
|
Pararas N, Pikouli A, Bounnah M, Zenah Y, Alkadrou AM, Papakonstantinou D, Dellaportas D, Pikoulis E. Laparoscopic Inguinal Hernia Repair in the Obese Patient Population: A Single-Center Five-Year Experience. Cureus 2023; 15:e48265. [PMID: 38054158 PMCID: PMC10695410 DOI: 10.7759/cureus.48265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose The objective of the present study is to evaluate the distribution of the transabdominal preperitoneal (TAPP) and the totally extraperitoneal repair (TEP) procedures among the obese and non-obese patient populations, to show how obesity impacts daily practice by reviewing the experience of a single center, and finally, to assess the outcomes of the operations. Methods All patients who underwent elective, minimally invasive inguinal hernia repair in our hospital from January 2017 to January 2022 were included in the present study. The data that were analyzed were patient demographics, each individual patient's American Society of Anesthesiology (ASA) score, the minimally invasive technique (TAPP or TEP) utilized, the body mass index (BMI), and other comorbidities such as underlying diabetes, hypertension, and smoking status. Results A total of 109 patients were included in the present analysis, of which 81 (74.3%) underwent elective TEP repairs while 28 (25.7%) underwent elective TAPP repairs. Overall, 39 (35.7%) patients were included in the obesity subgroup with an average BMI of 35.4 ± 4.9, with a range from 30.1 to 52.7, and 70 (64.3%) were included in the non-obese subgroup, with an average BMI of 23.2 ± 3.3 and a range from 16.2 to 29.7. Conclusions The laparoscopic approach to the inguinal hernia repair in obese patients has similar outcomes as an open approach regarding the 30-day events, in the hands of experienced surgeons with the advantages of the laparoscopic approach vs. the open one.
Collapse
Affiliation(s)
- Nikolaos Pararas
- General Surgery, Dr Sulaiman Al Habib Hospital, Alfaisal University, Riyadh, SAU
- 3rd Surgical Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Anastasia Pikouli
- 3rd Surgical Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Yousef Zenah
- General Surgery, Dr. Sulaiman Al Habib Hospital, Riyadh, SAU
| | | | - Dimitrios Papakonstantinou
- 3rd Surgical Department, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Dionysios Dellaportas
- 3rd Surgical Department, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Emmanouil Pikoulis
- 3rd Surgical Department, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| |
Collapse
|
|
14
|
Jung S, Lee JH, Lee HS. Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:128-133. [PMID: 37712312 PMCID: PMC10505366 DOI: 10.7602/jmis.2023.26.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
Purpose Robotic hernia repair has increased in popularity since the introduction of da Vinci robots (Intuitive Surgical). However, we lack quantitative analyses of its potential benefits. Herein, we report our initial experience with robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair. Methods We retrospectively reviewed the data from patients who underwent R-TAPP inguinal hernia repair with a prosthetic mesh using the da Vinci platform. Data on patient characteristics and surgical outcomes were also collected. Results Twenty-one patients (including 20 male patients [95.2%]) with a mean age of 54.1 ±16.4 years and body mass index of 23.8 ± 1.9 kg/m2 underwent R-TAPP inguinal hernia repair. Bilateral hernia repair was performed in two patients (9.5%), and six patients (28.5%) with scrotal hernia underwent R-TAPP hernia repair. A sigmoid colon sliding hernia was present in three patients (14.3%). The mean operation and console times were 91.8 ± 20.4 minutes and 154.5 ± 26.2 minutes, and 61.4 ± 16.9 minutes and 128.0 ± 25.5 minutes for unilateral and bilateral inguinal hernia, respectively. Spermatic vessel injury was identified intraoperatively in one patient. Two minor postoperative complications, postoperative ileus, and wound seroma were reported. The mean duration of hospitalization was 3.8 ± 0.9 days. No recurrence or conversion to open surgery was required. Conclusion Our findings suggest that R-TAPP inguinal hernia repair is safe and feasible. Its cost-effectiveness, optimal procedural steps, and indications for a robotic approach require further investigation.
Collapse
Affiliation(s)
- Sungwoo Jung
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jin Ho Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyung Soon Lee
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
|
15
|
Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea. Medicina (B Aires) 2023; 59:medicina59030582. [PMID: 36984583 PMCID: PMC10059805 DOI: 10.3390/medicina59030582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.
Collapse
|
|
16
|
Dreifuss NH, Chang B, Schlottmann F, Cubisino A, Mangano A, Masrur MA, Bianco FM. Robotic inguinal hernia repair: is the new Da Vinci single port platform providing any benefit? Surg Endosc 2023; 37:2003-2013. [PMID: 36282359 DOI: 10.1007/s00464-022-09737-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP). METHODS A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain. RESULTS MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1 min, p = 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6 min, p < 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%, p = 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6 months for MP-TAPP and 13.3 months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups. CONCLUSION Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform.
Collapse
Affiliation(s)
- Nicolas H Dreifuss
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA.
| | - Betty Chang
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Francisco Schlottmann
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Antonio Cubisino
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Mario A Masrur
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| | - Francesco M Bianco
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA
| |
Collapse
|
|
17
|
Li C, Zhang T, Wang H, Hou Z, Zhang Y, Chen W. Advanced surgical tool: Progress in clinical application of intelligent surgical robot. SMART MEDICINE 2022; 1:e20220021. [PMID: 39188736 PMCID: PMC11235784 DOI: 10.1002/smmd.20220021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2024]
Abstract
Surgical robot is a revolutionary tool conceived in the progress of clinical medicine, computer science, microelectronics and biomechanics. It provides the surgeon with clearer views and more comfortable surgical postures. With the assistance of computer navigation during delicate operations, it can further shorten the patient recovery time via reducing intraoperative bleeding, the risk of infection and the amount of anesthesia needed. As a comprehensive surgical revolution, surgical robot technique has a wide range of applications in related fields. This paper reviews the development status and operation principles of these surgical robots. At the same time, we also describe their up-to-date applications in different specialties and discusses the prospects and challenges of surgical robots in the medical area.
Collapse
Affiliation(s)
- Chao Li
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Tongtong Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Haoran Wang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Zhiyong Hou
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedicsthe Third Hospital of Hebei Medical UniversityOrthopaedic Research Institution of Hebei ProvinceNHC Key Laboratory of Intelligent Orthopaedic EquipmentShijiazhuangChina
| |
Collapse
|
|
18
|
Chinn J, Tellez R, Huy B, Farzaneh C, Christian A, Ramsay J, Kim H, Smith B, Hinojosa MW. Comparison of BMI on operative time and complications of robotic inguinal hernia repair at a VA medical center. Surg Endosc 2022; 36:9398-9402. [PMID: 35543772 DOI: 10.1007/s00464-022-09259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND BMI is a risk factor for recurrence and post-operative complications in both open and laparoscopic totally extraperitoneal approach (TEP) repair. Robotic surgery using the transabdominal preperitoneal approach (TAPP) is a safe and viable option for inguinal hernia repair (IHR). The objective of this study is to determine how difference in BMI influences rate of operative time, complications, and rate of recurrence in a robotic TAPP IHR. METHODS We performed a retrospective review of patients who underwent robotic inguinal hernia repair between 2012 and 2019 at a Veterans Health Administration facility (N = 304). The operating time, outcomes, and overall morbidity and mortality for robotic IHR were compared between three different BMI Groups. These groups were divided into: "Underweight/Normal Weight" (BMI < 25) n = 102, "Pre-Obese" (BMI 25-29.9) n = 120, and "Obese" (BMI 30 +) n = 82. RESULTS The average operating time of a bilateral IHR by BMI group was 83.5, 98.4, and 97.8 min for BMIs < 25, 25-29.9, and 30 +, respectively. Operating time was lower in the Underweight/Normal BMI group compared to the Pre-Obese group (p = 0.006) as well as the Obese group (p = 0.001). For unilateral repair, the average operation length by group was 65.2, 70.9, and 85.6 min for BMIs < 25, 25-29.9, and 30 +, respectively, demonstrating an increased time for Obese compared to Underweight/Normal BMI (p = 0.001) and for Obese compared to Pre-Obese (p = 0.01). Demographic/comorbidity variables were not significantly different, except for a higher percentage of white patients in the Underweight/Normal BMI group compared to the Pre-Obese and Obese groups (p = 0.02 and p = 0.0003). There was no significant difference in complications or recurrence. CONCLUSION BMI has a significant impact on the operating time of both unilateral and bilateral robotic hernia repair. Despite this increased operative time, BMI group did not differ significantly in postoperative outcomes or in recurrence rates.
Collapse
Affiliation(s)
| | - Rene Tellez
- Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | | | - Cyrus Farzaneh
- Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | - Ashton Christian
- Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
| | | | - Hubert Kim
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Brian Smith
- Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine Medical Center, 333 City Bldg. West, Suite 1600, Orange, CA, 92868, USA.
- VA Long Beach Healthcare System, Long Beach, CA, USA.
| |
Collapse
|
|
19
|
Hansen DL, Christophersen C, Fonnes S, Rosenberg J. Implementation of robot-assisted groin hernia repair diminishes the prospects of young surgeons' training: a nationwide register-based cohort study. Hernia 2022; 26:1653-1658. [PMID: 36201067 DOI: 10.1007/s10029-022-02691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Robot-assisted groin hernia repair is becoming more popular in recent years but may remove operations from surgical trainees. We aimed to investigate the educational level of the surgeons who performed robot-assisted groin hernia repair and the rate of supervision and compare this to open and laparoscopic groin hernia repair. METHODS This register-based study was reported according to the RECORD statement and used linked data from the Danish Hernia Database and the Danish Patient Safety Authority's Online Register. We included surgeons that performed robot-assisted, laparoscopic, and/or open groin hernia repairs performed between January 1, 2015, and June 15, 2021 in Denmark. RESULTS A total of 916 surgeons performing 43,856 groin hernia repairs were included in this study. Surgical specialists performed 98% of the robot-assisted groin hernia repairs, 89% of the laparoscopic repairs (p < 0.0001), and 54% of the Lichtenstein repairs (p < 0.0001). Only 5% of the robot-assisted groin hernia repairs were supervised compared with 11% of the laparoscopic repairs (p < 0.0001) and 28% of the open repairs (p < 0.0001). CONCLUSION Almost all groin hernia repairs performed with the robot-assisted technique were performed by surgeons specialized in general surgery. The proportions of surgeons specialized in surgery were higher for robot-assisted operations compared with laparoscopic or open groin hernia surgery. Thus, our data suggest a lack of involvement of surgeons in training, and this diminishes the educational potential in the pool of groin hernia operations by the use of robot-assisted repairs.
Collapse
Affiliation(s)
- D L Hansen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - C Christophersen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - S Fonnes
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - J Rosenberg
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| |
Collapse
|
|
20
|
Spampatti S, La Regina D, Pini R, Mongelli F, Gaffuri P, Porcellini I, Romanzi A, Marcantonio M. Three-point mesh fixation in robot-assisted transabdominal preperitoneal (R-TAPP) repair of 208 inguinal hernias: preliminary results of a single-center consecutive series. Langenbecks Arch Surg 2022; 407:2555-2561. [PMID: 35581394 DOI: 10.1007/s00423-022-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. METHODS Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3-0 suture. Patients were followed up at 10 and 30 days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. RESULTS Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1 week. Chronic pain (> 3 months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7 months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. CONCLUSIONS The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates.
Collapse
Affiliation(s)
- Sebastiano Spampatti
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland.
| | - Davide La Regina
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Lugano, via Tesserete 46, 6900, Lugano, Switzerland
| | - Paolo Gaffuri
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Iride Porcellini
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| | - Andrea Romanzi
- Department of Surgery, Ospedale Valduce, Via Dante Alighieri 11, 22100, Como, Italy
| | - Maria Marcantonio
- Ente Ospedaliero Cantonale Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, via Ospedale 12, 6500, Bellinzona, Switzerland
| |
Collapse
|
|
21
|
Chen J, Glasgow RE. What is the Best Inguinal Hernia Repair? Adv Surg 2022; 56:247-258. [PMID: 36096570 DOI: 10.1016/j.yasu.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the management of inguinal hernias have evolved over hundreds of years, so too has our paradigm of what constitutes the "best repair." To best answer what the ideal inguinal hernia repair is, the authors take an in-depth look at considerations to the patient, the provider, and the health care system.
Collapse
Affiliation(s)
- Jennwood Chen
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Veterans Affairs, Department of Surgery, 550 Foothill Dr, Salt Lake City, UT 84113, USA.
| | - Robert E Glasgow
- Univeristy of Utah, Department of Surgery, 50 Medical Dr N, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, 1950 Circle of Hope, Salt Lake City, UT 84112, USA.
| |
Collapse
|
|
22
|
Solaini L, Cavaliere D, Avanzolini A, Rocco G, Ercolani G. Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis. J Robot Surg 2022; 16:775-781. [PMID: 34609697 PMCID: PMC9314304 DOI: 10.1007/s11701-021-01312-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/26/2021] [Indexed: 11/04/2022]
Abstract
The aim of this study was to review the latest evidence on the robotic approach (RHR) for inguinal hernia repair comparing the pooled outcome of this technique with those of the standard laparoscopic procedure (LHR). A systematic literature search was performed in PubMed, Web of Science and Scopus for studies published between 2010 and 2021 concerning the comparison between RHR versus LHR. After screening 582 articles, 9 articles with a total of 64,426 patients (7589 RHRs) were eligible for inclusion. Among preoperative variables, a pooled higher ratio of ASA > 2 patients was found in the robotic group (12.4 vs 8.6%, p < 0.001). Unilateral hernia repair was more common in the laparoscopic group (79.9 vs 68.1, p < 0.001). Overall, operative time was longer in the robotic group (160 vs 90 min, p < 0.001); this was confirmed also in the sub-analysis on unilateral procedures (88 vs 68 min, p = 0.040). The operative time for robotic bilateral repair was similar to the laparoscopic one (111 vs 100, p = 0.797). Conversion to open surgery was 0% in the robotic group. The pooled rate of chronic pain and postoperative complications was similar between the groups. The standardized mean difference MD of the costs between LHR versus RHR was - 3270$ (95% CI - 4757 to - 1782, p < 0.001). In conclusion, laparoscopic and robotic inguinal hernia repair have similar safety parameters and postoperative outcomes. Robotic approach may require longer operative time if the unilateral repair is performed. Costs are higher in the robotic group.
Collapse
Affiliation(s)
- Leonardo Solaini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Forlì, Italy.
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, FC, Italy.
| | - Davide Cavaliere
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, FC, Italy
| | - Andrea Avanzolini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, FC, Italy
| | - Giuseppe Rocco
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, FC, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Forlì, Italy
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Via Forlanini 34, Forlì, FC, Italy
| |
Collapse
|
|
23
|
Learning curve of robotic inguinal hernia repair in the hands of an experienced laparoscopic surgeon: a comparative study. J Robot Surg 2022; 16:1307-1312. [DOI: 10.1007/s11701-021-01362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
|
|
24
|
Hansen DL, Fonnes S, Rosenberg J. Spin is present in the majority of articles evaluating robot-assisted groin hernia repair: a systematic review. Surg Endosc 2022; 36:2271-2278. [PMID: 35024934 DOI: 10.1007/s00464-021-08990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The number of scientific articles published each year is increasing, resulting in greater competition to get work published. Spin is defined as specific reporting strategies used to distort the readers' interpretation of results so that they are viewed more favorable. However, prevalence of spin in studies comparing robot-assisted groin hernia repair with traditional methods is unknown. OBJECTIVES/AIM To determine the frequency and extent of spin in studies assessing robot-assisted groin hernia repair. METHODS This systematic review was reported according to PRISMA guidelines, and a protocol was registered at PROSPERO before data extraction. Database search included PubMed, EMBASE, and Cochrane Central. RESULTS Of 35 included studies, spin was present in 57%. Within these, 95% had spin present in the abstract and 80% in the conclusion of the article. There was no association between study size and spin (p > 0.05). However, presence of spin in studies positively minded towards robot-assisted hernia repair was higher (p < 0.001) compared with those against or being neutral in their view of the procedure. Furthermore, being funded by or receiving grants from Intuitive Surgical were associated with a higher prevalence of spin (p < 0.05) compared with those who were not. CONCLUSION Spin was found to be common in articles reporting on robot-assisted groin hernia repair, and presence of spin was higher in studies funded by or receiving grants from the robot company. This suggests that readers should be cautious when reading similar literature.
Collapse
Affiliation(s)
- Danni Lip Hansen
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Siv Fonnes
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Jacob Rosenberg
- Centre for Perioperative Optimisation, Department of Surgery, Herlev and Gentofte Hospitals, University of Copenhagen, Herlev, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| |
Collapse
|
|
25
|
Elakkad MS, ElBakry T, Bouchiba N, Halfaoui M, ElOsta A, Qabbani A, Singh R, Aboumarzouk OM. Robotic Inguinal Hernia Repair and Obesity, Where Do We Stand? Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Tamer ElBakry
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Nizar Bouchiba
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Mourad Halfaoui
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | | | - Amjad Qabbani
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Omar M. Aboumarzouk
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Surgery, College of Medicine, Qatar University, Doha, Qatar
- Department of Surgery, University of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, Scotland, United Kingdom
| |
Collapse
|
|
26
|
Saito T, Fukami Y, Kurahashi S, Yasui K, Uchino T, Matsumura T, Osawa T, Komatsu S, Kaneko K, Sano T. Current status and future perspectives of robotic inguinal hernia repair. Surg Today 2021; 52:1395-1404. [PMID: 34860300 DOI: 10.1007/s00595-021-02413-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022]
Abstract
With more than 5500 da Vinci Surgical System (DVSS) installed worldwide, the robotic approach for general surgery, including for inguinal hernia repair, is gaining popularity in the USA. However, in many countries outside the USA, robotic surgery is performed at only a few advanced institutions; therefore, its advantages over the open or laparoscopic approaches for inguinal hernia repair are unclear. Several retrospective studies have demonstrated the safety and feasibility of robotic inguinal hernia repair, but there is still no firm evidence to support the superiority of robotic surgery for this procedure or its long-term clinical outcomes. Robotic surgery has the potential to overcome the disadvantages of conventional laparoscopic surgery through appropriate utilization of technological advantages, such as wristed instruments, tremor filtering, and high-resolution 3D images. The potential benefits of robotic inguinal hernia repair are lower rates of complications or recurrence than open and laparoscopic surgery, with less postoperative pain, and a rapid learning curve for surgeons. In this review, we summarize the current status and future prospects of robotic inguinal hernia repair and discuss the issues associated with this procedure.
Collapse
Affiliation(s)
- Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan.
| | - Yasuyuki Fukami
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Kohei Yasui
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Tatsuki Matsumura
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Karimata-Yazako, Nagakute, Aichi, 480-1195, Japan
| |
Collapse
|
|
27
|
Samalavicius NE, Dulskas A, Sirvys A, Klimasauskiene V, Janusonis V, Janusonis T, Eismontas V, Deduchovas O, Stephan D, Darwich I, Poth C, Schilcher F, Slabadzin Y, Kukharchuk M, Willeke F, Staib L. Inguinal hernia TAPP repair using Senhance ® robotic platform: first multicenter report from the TRUST registry. Hernia 2021; 26:1041-1046. [PMID: 34591213 DOI: 10.1007/s10029-021-02510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this article was to provide feasibility and safety results of robotic transabdominal preperitoneal inguinal hernia repair (Robotic TAPP). METHODS We included 271 cases of robotic inguinal hernia TAPP repair using the Senhance® robotic platform from four different centers between March 2017 and March 2020. Key data points were intraoperative and postoperative complication rate, operating time, length of hospital stay, postoperative pain score and time required to get back to a daily routine that were inserted in the TransEnterix European Patient Registry for Robotic assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery (TRUST). RESULTS We report 203 cases of unilateral and 68 cases of bilateral inguinal hernia repairs. Mean operative time was 74 ± 35 min (range 32-265 min), postoperative complications occurred in five (1.85%) cases, the intraoperative complication rate was five (1.85%). The average subjective patient-related pain score after the procedure was 3 ± 1.9 (range 1-9), length of hospital stay was 39 ± 28 h (range 4-288 h), and recovery time was 9.65 ± 8 days (range 1-36 days). CONCLUSION Robotic inguinal hernia TAPP repair shows inspiring results. It is a safe and doable procedure. However, cost analysis should be performed in future to show the superiority over other techniques.
Collapse
Affiliation(s)
- N E Samalavicius
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, 92288, Klaipeda, Lithuania.,Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 2 Santariskiu Str., 08660, Vilnius, Lithuania.,Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, 84 H. Manto str., 92294, Klaipeda, Lithuania
| | - A Dulskas
- Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 2 Santariskiu Str., 08660, Vilnius, Lithuania. .,Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu Str., 08406, Vilnius, Lithuania.
| | - A Sirvys
- Vilnius University, Faculty of Medicine, M. K. Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | | | - V Janusonis
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, 92288, Klaipeda, Lithuania.,Health Research and Innovation Science Center, Faculty of Health Sciences, Klaipeda University, 84 H. Manto str., 92294, Klaipeda, Lithuania
| | - T Janusonis
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Anesthesiology and Intensive Care, Klaipeda University Hospital, Klaipeda, Lithuania
| | - V Eismontas
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, 92288, Klaipeda, Lithuania
| | - O Deduchovas
- Department of Surgery, Klaipeda University Hospital, 41 Liepojos Str, 92288, Klaipeda, Lithuania
| | - D Stephan
- Department of General and Visceral Surgery, Minimal Invasive Surgery and Robotics, St. Marien-Krankenhaus, Siegen, Germany
| | - I Darwich
- Department of General and Visceral Surgery, Minimal Invasive Surgery and Robotics, St. Marien-Krankenhaus, Siegen, Germany
| | - C Poth
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - F Schilcher
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| | - Y Slabadzin
- Republican Clinical Medical Center of the Administration of the President of the Republic of Belarus, Minsk, Belarus
| | - M Kukharchuk
- Republican Clinical Medical Center of the Administration of the President of the Republic of Belarus, Minsk, Belarus
| | - F Willeke
- Department of General and Visceral Surgery, Minimal Invasive Surgery and Robotics, St. Marien-Krankenhaus, Siegen, Germany
| | - L Staib
- Department of General and Visceral Surgery, Klinikum Esslingen, Esslingen, Germany
| |
Collapse
|
|
28
|
Robotic Inguinal Hernia Repair After Prostatectomy: How to Navigate Safely. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:66-72. [PMID: 34545032 DOI: 10.1097/sle.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In recent decades, minimally invasive approaches have found their place in treating a specific subset of patients with inguinal hernias, predominantly those with recurrent or bilateral disease. Classically, prior history of urologic pelvic operations, such as prostatectomy, has been listed as relative contraindication for minimally invasive inguinal hernia repair. As the adoption of the robotics platform continues to grow, we aim to outline a feasible robotic-assisted inguinal hernia repair technique in patients with previous prostatectomies. We report the outcomes of 15 patients who underwent repair at 2 institutions. METHODS This is a retrospective case series of 15 patients who underwent robotic transabdominal preperitoneal approach repair of their inguinal hernias after prostatectomy. Demographics, intraoperative variables, and outcomes of our cases are described. RESULTS Fifteen patients were included in our cohort. All patients had a history of prostatectomy (7 open, 2 laparoscopic, and 6 robotic) due to prostate cancer. Median age was 70 years old (range: 60 to 89 y), with a median body mass index of 26.3 kg/m2 (range: 20.5 to 37.4 kg/m2). Hernia defects were bilateral in 6 patients and unilateral in the remaining 9 (right; 6, left; 3). The shortest interval between prostatectomy and subsequent hernia repair was 4 months (range: 4 to 216 mo). The median operative time was 139 min (range: 91 to 281 min). All defects were repaired using a polypropylene mesh except in 1 case, where a coated monofilament polyester mesh was used after having a large peritoneal defect to close, preventing future adhesions to the bowel. Mesh sizes used were large (16×11 cm), extra-large (17×12 cm) for anatomic mesh, and 20×15 cm for the monofilament polyester mesh. The mesh was fixed in 14 of 15 cases. Fixation was accomplished with absorbable suture (n=13), barbed suture (n=1), and fibrin sealant (n=1). Peritoneal closure was always performed using a continuous running v-loc suture. There were no documented major intraoperative complications, no 30-day readmission, or recurrences recorded within the follow-up period. Postoperatively, only 2 seromas and 1 hematoma were documented during the follow-up period. CONCLUSIONS Robotic inguinal hernia repairs in patients with previous prostatectomy is safe and feasible in most patients. Larger patient series are needed to confirm these findings.
Collapse
|
|
29
|
Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
Collapse
Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| |
Collapse
|
|
30
|
Young E, Vissapragada R, Bulamu NB, Raju DP, McDonald CR. Outsourcing robotic-assisted operations to private hospitals: Cost analysis of a retrospective cohort. ANZ J Surg 2021; 91:2352-2359. [PMID: 34251743 DOI: 10.1111/ans.17040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/07/2021] [Accepted: 06/12/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND The Lyell McEwin Hospital entered into a public-private collaborative agreement in 2019 in order to access Da Vinci® Xi Surgical Systems (Intuitive Surgical, Sunnyvale, CA, USA) in private hospitals. This study aimed to examine the costs associated with usage of robot surgical systems under the agreement, and the potential for acquisition in the public hospital. METHODS Retrospective data on robotic-assisted and equivalent operations performed between 1 May 2019 and 30 April 2020 were collected and formed subsequent model inputs. Cost data were from hospital records and the local Da Vinci® Xi distributor. Clinical workflow of operations was simulated with a decision-analytic model, with output being costs incurred. The model's base case scenario assumed 5% of cases were robotically assisted. RESULTS A total of 35 robotic-assisted, 101 laparoscopic and 34 open operations were performed. Patients were predominantly male and overweight with multiple comorbidities. Length of stay and duration of operation were associated with increased costs (p < 0.001, r2 0.72). In the base case scenario, there was a cost of AU$26 424 per patient, with an open conversion rate of 11%. Increasing robotic-assisted case percentage resulted in reduced cost, open conversion rates and length of stay. Extrapolation of cost model data indicated if 50% were robotic-assisted cases, then the initial capital investment (assumed at AU$4 000 000) could be recovered in 10 years. CONCLUSION Our model highlights potential advantages of performing greater numbers of robotic-assisted operations in a collaborative environment. Cost-effective analysis with prospective data could evaluate if these results are translatable and potentially support acquisition of robotic systems in the public sector.
Collapse
Affiliation(s)
- Edward Young
- Division of Surgical Specialties and Anaesthetics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ravi Vissapragada
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Devinder Philip Raju
- Division of Surgical Specialties and Anaesthetics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Christopher Richard McDonald
- Division of Surgical Specialties and Anaesthetics, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| |
Collapse
|
|
31
|
Aiolfi A, Bonitta G. Do TEP and TAPP have similar effect on postoperative pain? Author's reply. Hernia 2021; 25:1403-1404. [PMID: 34138369 DOI: 10.1007/s10029-021-02447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Aiolfi
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - G Bonitta
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| |
Collapse
|
|
32
|
Comparison of perioperative outcomes between non-obese and obese patients undergoing robotic inguinal hernia repair: a propensity score matching analysis. Hernia 2021; 26:1033-1039. [PMID: 34057626 DOI: 10.1007/s10029-021-02433-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/24/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Despite the limited research in support of robotic inguinal hernia repair (RIHR), it is an increasingly adopted technique in surgical practice. While a major risk factor for the development of ventral hernias and subsequent complications, obesity in RIHR has not been investigated. The aim of this study was to compare the outcomes of RIHR between obese and non-obese patients. METHODS Prospectively collected data surrounding RIHRs performed at a single center between 2013 and 2020 were retrospectively reviewed. Patients were divided into non-obese (< 30 kg/m2) and obese (≥ 30 kg/m2) groups, and preoperative, intraoperative, and postoperative variables were compared in unmatched and matched groups, derived using a 1:2 propensity score match (PSM). RESULTS From a total of 547 patients, 414 were non-obese and 133 were obese. A PSM analysis, accounting for confounding preoperative variables and risk factors, stratified these into 262 patients for the non-obese group and 131 patients for the obese group. Although the obese group's operative times were longer on average (57 min vs. 51 min; p = 0.007), this difference did not persist after matching. The only significant difference in operative variables was a higher rate of cord lipomas in the obese group. Postoperative variables, including wound complications, readmissions, and recurrence, were similar across unmatched and matched groups. CONCLUSION In the first study to investigate the influence of obesity in RIHR, no differences in outcomes were found between obese and non-obese patients. This procedure can be safely performed in obese individuals, however, more studies comparing body mass index (BMI) classes are needed to establish whether a prohibitive BMI threshold exists for RIHR.
Collapse
|
|
33
|
Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Lombardo F, Bonitta G, Bruni PG, Panizzo V, Campanelli G, Bona D. Total extraperitoneal (TEP) versus laparoscopic transabdominal preperitoneal (TAPP) hernioplasty: systematic review and trial sequential analysis of randomized controlled trials. Hernia 2021; 25:1147-1157. [PMID: 33851270 PMCID: PMC8514389 DOI: 10.1007/s10029-021-02407-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/29/2021] [Indexed: 01/09/2023]
Abstract
Purpose To examine the updated evidence on safety, effectiveness, and outcomes of the totally extraperitoneal (TEP) versus the laparoscopic transabdominal preperitoneal (TAPP) repair and to explore the timely tendency variations favoring one treatment over another. Methods Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were consulted. Risk Ratio (RR), weighted mean difference (WMD), and 95% confidence intervals (CI) were used as pooled effect size measures. Results Fifteen RCTs were included (1359 patients). Of these, 702 (51.6%) underwent TAPP and 657 (48.4%) TEP repair. The age of the patients ranged from 18 to 92 years and 87.9% were males. The estimated pooled RR for hernia recurrence (RR = 0.83; 95% CI 0.35–1.96) and chronic pain (RR = 1.51; 95% CI 0.54–4.22) were similar for TEP vs. TAPP. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus supporting true negative results while the information size was calculated as adequate for both outcomes. No significant differences were found in term of early postoperative pain, operative time, wound-related complications, hospital length of stay, return to work/daily activities, and costs. Conclusions TEP and TAPP repair seems comparable in terms of postoperative hernia recurrence and chronic pain. The cumulative evidence and information size are sufficient to provide a conclusive evidence on recurrence and chronic pain. Similar trials or meta-analyses seem unlikely to show diverse results and should be discouraged. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02407-7.
Collapse
Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy.
| | - Marta Cavalli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Simona Del Ferraro
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Livia Manfredini
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Francesca Lombardo
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Piero Giovanni Bruni
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Valerio Panizzo
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| | - Giampiero Campanelli
- Department of Surgery, Istituto Clinico Sant'Ambrogio, University of Insubria, Milan, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Milan, Italy
| |
Collapse
|
|
34
|
Learning curve of robot-assisted transabdominal preperitoneal (rTAPP) inguinal hernia repair: a cumulative sum (CUSUM) analysis. Surg Endosc 2021; 36:1827-1837. [PMID: 33825019 DOI: 10.1007/s00464-021-08462-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP-IHR) is a safe and feasible approach for hernias of varying etiology. We aim to present a single surgeon's learning curve (LC) of this technique based on operative times, while accounting for bilaterality and complexity. METHODS This is a retrospective cohort analysis of patients who underwent rTAPP-IHR over a period of 5 years. Patients who underwent primary, recurrent, and complex (previous posterior repair, previous prostatectomy, scrotal, incarcerated) repairs were included. Cumulative and risk-adjusted cumulative sum analyses (CUSUM and RA-CUSUM) were used to depict the evolution of skin-to-skin times and complications/surgical site events (SSEs) with time, respectively. RESULTS A total of 371 patients were included in the study. Mean skin-to-skin times were stratified according to four subgroups: unilateral non-complex (46.8 min), unilateral complex (63.2 min), bilateral non-complex (70.9 min), and bilateral complex (102 min). A CUSUM-LC was then plotted using each procedures difference in operative time from its subgroup mean. The peak of the plot occurred at case number 138, which was used as a transition between 'early' and 'late' phases. The average operative time for the late phase was 15.9 min shorter than the early phase (p < 0.001). The RA-CUSUM, plotted using the weight of case complexity and unilateral/bilateral status, also showed decreasing SSE rates after the completion of 138 cases (early phase: 8.8% vs. late phase: 2.2%, p = 0.008). Overall complication rates did not differ significantly between the two phases. CONCLUSIONS Our study shows that regardless of bilateral or complex status, rTAPP operative times and SSE rates gradually decreased after completing 138 procedures. Previous laparoscopic experience, robotic team efficiency, and surgical knowledge are important considerations for a surgeon's LC.
Collapse
|
|
35
|
VIDEOUROLOGY ABSTRACTS. J Endourol 2021. [DOI: 10.1089/end.2021.29110.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
|
36
|
Qabbani A, Aboumarzouk OM, ElBakry T, Al-Ansari A, Elakkad MS. Robotic inguinal hernia repair: systematic review and meta-analysis. ANZ J Surg 2021; 91:2277-2287. [PMID: 33475236 DOI: 10.1111/ans.16505] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Amjad Qabbani
- Surgical Department, Hamad Medical Corporation, Doha, Qatar
| | - Omar M Aboumarzouk
- Surgical Department, Hamad Medical Corporation, Doha, Qatar.,School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK.,College of Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Tamer ElBakry
- Surgical Department, Hamad Medical Corporation, Doha, Qatar
| | | | | |
Collapse
|
|
37
|
Aiolfi A, Cavalli M, Del Ferraro S, Manfredini L, Bonitta G, Bruni PG, Bona D, Campanelli G. Treatment of Inguinal Hernia: Systematic Review and Updated Network Meta-Analysis of Randomized Controlled Trials. Ann Surg 2021; 274:954-961. [PMID: 33427757 DOI: 10.1097/sla.0000000000004735] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the advent of innovative surgical platforms and operative techniques, a definitive indication of the best surgical option for the treatment of unilateral primary inguinal hernia remains unsettled. Purpose was to perform an updated and comprehensive evaluation within the major approaches to inguinal hernia. METHODS Systematic review and network meta-analyses of Randomized Controlled Trials (RCTs) compare Lichtenstein tension-free repair, laparoscopic transabdominal preperitoneal (TAPP) repair, and totally extraperitoneal repair (TEP). Risk Ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% Credible Intervals (CrI) were used to assess relative inference. RESULTS Thirty-five RCTs (7,777 patients) were included. Overall, 3,496 (44.9%) underwent Lichtenstein, 1,269 (16.3%) TAPP, and 3,012 (38.8%) TEP repair. The Visual Analogue Scale (VAS) was significantly lower for minimally invasive repair at <12-hour, 24 hours, and 48 hours. Postoperative chronic pain [TAPP vs. Lichtenstein (RR = 0.36; 95% CrI 0.15-0.81) and TEP vs. Lichtenstein (RR = 0.36; 95% CrI 0.21-0.54)] and return to work/activities [TAPP vs. Lichtenstein (WMD = -3.3; 95% CrI -4.9; -1.8) and TEP vs. Lichtenstein (WMD = -3.6; 95% CrI -4.9; -2.4)] were significantly reduced for minimally invasive approaches. Wound hematoma and infection were significantly reduced for minimally invasive approaches while no differences were found for seroma, hernia recurrence, and hospital length of stay. CONCLUSIONS Minimally invasive TAPP and TEP repair seem associated with significantly reduced early postoperative pain, return to work/activities, chronic pain, hematoma, and wound infection compared to the Lichtenstein tension-free repair. Hernia recurrence, seroma, and hospital length of stay seem similar across treatments.
Collapse
Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy Department of Pathophysiology and Transplantation, INCO and Department of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Bou-Ayash N, Gokcal F, Kudsi OY. Robotic Inguinal Hernia Repair for Incarcerated Hernias. J Laparoendosc Adv Surg Tech A 2020; 31:926-930. [PMID: 33180657 DOI: 10.1089/lap.2020.0607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: This is the first study to investigate clinical outcomes after robotic emergent inguinal hernia repair (rEIHR). Methods: Data were retrospectively analyzed from patients who underwent rEIHR from 2013 to 2020. Any patients who underwent concomitant nonabdominal wall procedures were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCI®) scoring systems. Results: Out of 616 patients who underwent inguinal herniorrhaphy throughout the study period, 23 rEIHRs were identified among 19 patients. The median Acute Physiology and Chronic Health Evaluation-II score was 6, and the average skin-to-skin time was 75.9 minutes. The average length of stay (LOS) was 1.4 days. During the mean follow-up period of 31.7 months, a total of three complications (CD-grades I, II, and IVa) in two patients were observed. The median CCI score was 0 (max = 43.3). Conclusion: rEIHR is a feasible option for surgeons to utilize, with a short LOS and low complication rate, given the sufficient experience and support as well as the appropriate patient selection.
Collapse
Affiliation(s)
- Naseem Bou-Ayash
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA, USA
| | - Fahri Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA, USA
| | - Omar Yusef Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA, USA
| |
Collapse
|
|
39
|
Robotic-assisted single site (RASS) TAPP: an advantageous choice? : Outcomes of single site robotic groin hernia repair. Hernia 2020; 24:1057-1062. [PMID: 32712836 DOI: 10.1007/s10029-020-02274-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Laparoscopic transabdominal preperitoneal (TAPP) is a valid option for bilateral primary groin hernia and recurrent cases. Robotic approach for inguinal hernia is still debated. The aim of this study is to investigate the potential role of robotic-assisted single site-TAPP (RASS-TAPP) reporting our experience. METHODS We performed 44 RASS TAPP in 32 patients from February 2016 to July 2018. Data on patient demographics, type of hernia, operative time, complications, recurrence rate and hospital stay were retrospectively analyzed. Follow-up was scheduled at 1 week, 4 months and 1 year after surgery. RESULTS Forty-two hernias were treated in 32 patients (27 M). Mean age was 48.6 years (range 20-67), mean BMI was 26.49 kg/m2 (range 16-34.9). Mean operative time was 54.8 min (range 28-150). In two cases (6%) a conversion to laparoscopy was necessary. At 1 week, two scrotal hematomas and four seromas were observed and treated conservatively. At 4 months follow-up, one patient (3.1%) complained temporary pain. No patient had inguinal recurrence or incisional umbilical hernia and chronic pain at 1-year follow-up. CONCLUSION RASS TAPP is feasible and safe with a high patient satisfaction. However, the surgeon experiences a technical discomfort due to the conflict of the instrumentation which influences negatively the choice of this approach, despite the better vision and augmented dexterity provided by the robot.
Collapse
|
|
40
|
Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
Collapse
Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| |
Collapse
|
|
41
|
|
|
42
|
Aiolfi A, Cavalli M, Micheletto G, Bruni PG, Lombardo F, Morlacchi A, Bonitta G, Campanelli G, Bona D. Open mesh vs. suture umbilical hernia repair: systematic review and updated trial sequential meta-analysis of randomized controlled trials. Hernia 2020; 24:707-715. [DOI: 10.1007/s10029-020-02146-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
|
|
43
|
Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc 2020; 34:1458-1464. [PMID: 32076858 DOI: 10.1007/s00464-020-07449-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although laparoscopic inguinal hernia repair was described about 30 years ago and advantages of the technique have been demonstrated, the utilization of this approach has not been what we would expect. Some reasons may be the need for surgeons to understand the posterior anatomy of the groin from a new vantage point, as well as to acquire advanced laparoscopic skills. Recently, however, the introduction of a robotic approach has dramatically increased the adoption of minimally invasive techniques for inguinal hernia repair. METHODS Important recent contributions to this evolution have been the establishment of a new concept known as the critical view of the Myopectineal Orifice (MPO) and the description of a new way of understanding the posterior view of the antomy of the groin (inverted Y and the five triangles). In this paper, we describe 10 rules for a safe MIS inguinal hernia repair (TAPP, TEP, ETEP, RTAPP) that combines these two new concepts in a unique way. CONCLUSIONS As the critical view of safety has made laparoscopic cholecystectomy safer, we feel that following our ten rules based on understanding the anatomy of the posterior groin as defined by zones and essential triangles and the technical steps to achieve the critical view of the MPO will foster the goal of safe MIS hernia repair, no matter which minimally invasive technique is employed.
Collapse
Affiliation(s)
- Christiano Claus
- Minimally Invasive Surgery Department, Jacques Perissat Institute, Positivo University, Jeremias Maciel Perretto St, 300, Curitiba, 81210-310, Brazil.
| | | | - Flavio Malcher
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, USA
| | | | - Edward Felix
- Department of Surgery, Marian Regional Medical Center, Santa Maria, CA, USA
| |
Collapse
|
|
44
|
The paradox of the robotic approach to inguinal hernia repair in the inpatient setting. Am J Surg 2019; 219:497-501. [PMID: 31558306 DOI: 10.1016/j.amjsurg.2019.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Robotics offers improved ergonomics, enhanced visualization, and increased dexterity. Disadvantages include startup, maintenance and instrument costs. Surgeon education notwithstanding, we hypothesized that robotic inguinal hernia repair carries minimal advantages over the open or laparoscopic approach in the inpatient setting. METHODS The HCUP-SID and AHA datasets were queried for inguinal hernia repair codes. Hospital and patient demographic, financial and comorbidity data were evaluated. Data are presented as mean ± SEM. RESULTS 36396 cases (27776 Open, 7104 Laparoscopic and 1516 Robotic) were identified. Total costs were: $13595 ± 104 (Open), $13581 ± 176 (Laparoscopic) and $18494 ± 323 (Robotic). (p < 0.0001 Robotic vs Open, Robotic vs Laparoscopic) Robotic costs were 38% greater than that of the Open and Laparoscopic subsets (p < 0.001 Robotic vs. Open and Laparoscopic). The Open, Laparoscopic and Robotic subsets' length of stay were 4.2, 3.2 and 2.3 days, respectively. (p < 0.0001 among Open, Laparoscopic and Robotic). CONCLUSION The Robotic approach to the inguinal hernia repair had the lowest length of stay, despite having the highest costs. The benefits of robotic surgery in inguinal hernia repair are unclear in the inpatient setting.
Collapse
|
|
45
|
Aiolfi A, Cavalli M, Bonitta G, Bona D. Inguinal hernia repair in centers of excellence. Author's reply. Hernia 2019; 24:215. [PMID: 31321569 DOI: 10.1007/s10029-019-02010-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - M Cavalli
- Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Istitituto Clinico Sant'Ambrogio, University of Milan, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| |
Collapse
|
|
46
|
Inguinal hernia repair in centers of excellence. Hernia 2019; 24:213-214. [DOI: 10.1007/s10029-019-01998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/17/2023]
|
|
47
|
Comment on robotic inguinal hernia repair: is technology taking over? Hernia 2019; 23:521-522. [PMID: 31129794 DOI: 10.1007/s10029-019-01984-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
|
|
48
|
Primary unilateral not complicated inguinal hernia with an effective, cheap, less invasive, and easy operation: the Trabucco repair. Hernia 2019; 23:555-560. [PMID: 31119472 DOI: 10.1007/s10029-019-01975-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND In modern abdominal wall hernia surgery, the achievement of the most effective tailored repair for each specific defect with the less possible invasiveness, the quicker recovery, the lower costs and the fewer risk of local occurrences, recurrences and chronic pain is the most desirable and cutting-edge goal. METHODS Since 1989 about 4219 primary unilateral not complicated inguinal hernias have been treated with specific indications with a sutureless and minimally invasive anterior open approach. The great majority of these procedures were performed under local anaesthesia in a day surgery regimen, with a systematic and careful nerve sparing, preservation of cremasteric muscle, and with a 3-5 cm skin incision. RESULTS The minimally invasive sutureless nerve sparing open approach has shown a very low rate of seromas (0.45%), haematomas (0.24%) and infections (0.07%) while the width of skin incision challenges even laparoscopy. A significant reduction of both postoperative pain (2.7%) and chronic neuralgia (0.047%) has led to excellent outcomes in patients, also in terms of quality of life. Compared to the Lichtenstein's tension-free technique, which is at now the gold standard open treatment for primary inguinal hernia worldwide, there are no significant differences in the observed recurrence rate (well below 1%). CONCLUSION In our experience of almost 30 years we have been able to experiment and refine more and more the sutureless technique proposed by Trabucco for the treatment of primitive inguinal hernia, peer to peer, improving the local anaesthesia and the ability to detect hidden defects during the repair (Spigelian included), reducing the width of the incisions and tractions on the tissues, introducing the concept of a gentle and bloodless "finger surgery" according to a minimally invasive, extremely anatomic, safe, inexpensive, very effective anterior open approach.
Collapse
|