Inguinal hernia repair: is there a benefit to using the robot?

Patriota

ABCD, arq. bras. cir. dig.

et al. 2018

Introduction:Inguinal hernia is one of the most frequent surgical diseases. Currently, with the advantages of minimally invasive surgery, new questions arise: what will be the best approach for correction of inguinal hernia? Is there real benefit to the robotic approach? Objective:To compile results of the published studies that used the robot-assisted technique in the repair of inguinal hernia, analyzing its limitations, complications and comparing it with those of the pre-existing techniques. Method:The review was performed from the Medline database with the following descriptors: (inguinal hernia repair OR hernioplasty OR hernia) AND (robot OR robotic OR robotic assisted) being retrieved 391 articles. After verification of the titles and abstracts, we identified eight series of cases congruent with the objectives of this review. Three reviewers participated in the extraction and selection of results. Results:Comparative studies showed an increase in surgical time in relation to the open and videolaparoscopic approach. The complications present similar rates with the other repair routes. Conclusion:This technique has been shown to be effective for the correction of inguinal hernia, but the benefits of using robotic surgery are unclear. So, there is a need for randomized studies comparing laparoscopic to robotic repair

Section: Resultsmentioning

confidence: 95%

“…There was also the use of a self-adjusting polyester mesh with microstaples 7 and mesh fixation with Prolene ®13 . Only one study did not specify the mesh type used 9 .…”

Section: Resultsmentioning

confidence: 99%

Inguinal Repair via Robotic Assisted Technique: Literature Review

Patriota

ABCD, arq. bras. cir. dig.

et al. 2018

Robotics Computer Surgery

“…However, transition from laparoscopy to robotics for inguinal hernia repair should be considered cautiously due to increased costs and higher operative time. 42,43 There are several limitations in our study. We do not have the operative and postoperative data, and this limits our interpretation in terms of any association between case volume and outcomes.…”

Section: Discussionmentioning

confidence: 94%

“…Requirement of a long learning curve of L‐TEP may be one of the factors directing surgeons to seek new minimally invasive techniques. However, transition from laparoscopy to robotics for inguinal hernia repair should be considered cautiously due to increased costs and higher operative time …”

Section: Discussionmentioning

confidence: 99%

Adoption of robotic technology in Turkey: A nationwide analysis on caseload and platform used

Esen

Aytaç

Ozben

et al. 2018

Background Limited data exist regarding adoption of evolving robotic technology in surgery. This study evaluated trends and the current condition of robotic platforms in surgical specialties and general surgical subspecialties. Methods Between January 2013 and December 2017, all robotic operations performed in Turkey were included. Results In the study period, 13 760 robotic operations were performed at 32 hospitals. The median numbers of general surgical procedures were 43and eight cases per hospital and per general surgeon, respectively. The high‐volume general surgeons performed 1734 (81%) of the cases. Forty‐five percent and 55% of the general surgical operations were performed with the Xi and S/Si robots, respectively. Conclusion Use of the Xi platform seems to increase caseload in general surgery operations possibly by facilitating robotic colorectal surgery. Targeting the high‐volume centres and surgeons for further training and implantation of upcoming robotic technology can be more effective in terms of increasing case volume and improving outcomes.

Robotics Computer Surgery

“…Therefore, groin hernia repair has rapidly gained popularity in the past decade, especially during a robot‐assisted radical prostatectomy, which potentially increases the incidence of groin hernias after surgery . However, whether we really need a surgical robot just for repairing a simple groin hernia is still questionable due to its higher cost, longer operative time, and uncertainty about its clinical benefits …”

Section: Discussionmentioning

confidence: 99%

Novel robot‐assisted laparoscopic total extra‐peritoneal repair with primary fascial closure plus pre‐peritonea mesh for large groin defects

Chen

et al. 2019

Background:Since the introduction of robot-assisted laparoscopic surgery, a variety of conventional laparoscopic procedures have been explored via this approach. In the robotic era, most of the reported robot-assisted laparoscopic hernia repairs were performed with the trans-abdominal pre-peritoneal approach.According to the evidence extrapolated from laparoscopic ventral hernia repair, simultaneous fascial defect closure and mesh repair can significantly decrease the risk of seroma formation and recurrence over those without fascial closure.Therefore, we describe our novel technique of robot-assisted total extraperitoneal (TEP) repair with primary fascial closure and pre-peritoneal mesh and its preliminary clinical outcomes. Methods: We retrospectively reviewed our prospectively collected hernia database from October 2017 to July 2019, which included 26 consecutive patients with primary or recurrent groin hernias. Patients' baseline characteristics and perioperative outcomes were compared and analyzed. Perioperative factors included operative time, visual analog scale (VAS) score (0-100), hospital stay, perioperative complications, time to return to normal activity, and the modified Medical Outcome Study (MOS; item 3-12/36 items) score. Results: All procedures were completed successfully without conversion to open or conventional laparoscopic surgery. The patients' age ranged from 28 to 74 years (median 57.5). The mean operative time was 115 minutes (range 95-172 min). There were no major procedure-related complications. Only four cases experienced asymptomatic seromas, which were detected by ultrasonography; and all resolved spontaneously within 6 weeks after the operation. The VAS and modified MOSs revealed quick recovery after robot-assisted endoscopic TEP repair.Conclusions: Robot-assisted endoscopic TEP repair combined with primary fascial closure and pre-peritoneal mesh is a safe and feasible technique for groin hernia repair.