Preliminary results of robotic inguinal hernia repair following its introduction in a single‐center trial

Abstract

Aim Robotic surgery using the da Vinci system has markedly increased worldwide. However, robotic inguinal hernia repair remains unpopular outside the United States. We introduced and evaluated a robotic transabdominal preperitoneal repair (R‐TAPP) technique for inguinal hernia in our hospital. Methods First, we designed a task protocol according to the surgical results of 388 laparoscopic TAPP (L‐TAPP) procedures performed during the 4 years prior to introducing R‐TAPP. Our task protocol included several time limitations during a step‐wise procedure: creating the peritoneal flap (<60 minutes), mesh placement with fixation (<30 minutes), and peritoneal suture closure (<30 minutes) under experienced supervision. We investigated the preliminary clinical results of R‐TAPP performed by a single operator between December 2018 and January 2020. Results We identified 27 lesions in 20 patients (unilateral in 13 and bilateral in seven). According to the Japan Hernia Society Classification, our cohort included eight type I, five type II, and seven bilateral hernias (nine type I, four type II, and one type IV). The median operation time was 124 minutes (range, 81‐164 minutes), and the median console operation time was 85 minutes (range, 50‐132). The median time required for the peritoneal incision was 30 minutes (range, 18‐54 minutes), that for mesh placement (including tucking) was 13 minutes (range, 7‐27 minutes), and that for peritoneal suturing was 9 minutes (range, 3‐20 minutes). Conclusion Our preliminary results suggest that our task protocol for R‐TAPP is feasible. However, refinement of our task protocol is essential for standardization.

The Experience of Robot-assisted Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair Following Robot-assisted Laparoscopic Radical Prostatectomy: A Cohort Study

“…Therefore, surgical cost will become an obstacle to patients with inguinal hernias and thereby make patient recruitment for R-TAPP di cult in Japan. However, several institutions have gradually shown evidence of spread of R-TAPP in Japan [34].…”

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

“…We used Cadiere forceps with the left hand and Maryland bipolar forceps (Intuitive Surgical) with the right hand. The Maryland bipolar forceps were connected to a VIO 300D electrosurgical generator (Erbe USA, Marietta, GA) in the forced coagulation mode 8,10 …”

“…All operations were performed under a protocol designed at our hospital by a single qualified surgeon (Takuya Saito) who completed the LC for laparoscopic inguinal hernia repair with the transabdominal preperitoneal approach (L‐TAPP) prior to performing R‐TAPP. 8 , 9 In addition, the operating surgeon performed more than 50 RGs within the study period. The patients' demographics, clinical characteristics, intraoperative data (console time, total operative time, and blood loss), and 30‐day postoperative outcomes (overall complications, length of stay, and readmission) were reviewed.…”

“…The Maryland bipolar forceps were connected to a VIO 300D electrosurgical generator (Erbe USA, Marietta, GA) in the forced coagulation mode. 8 , 10 …”

“…Between December 2018 and April 2021, consecutive patients who underwent R‐TAPP using the bipolar forceps dissection technique at our institution were investigated. All operations were performed under a protocol designed at our hospital by a single qualified surgeon (Takuya Saito) who completed the LC for laparoscopic inguinal hernia repair with the transabdominal preperitoneal approach (L‐TAPP) prior to performing R‐TAPP 8,9 . In addition, the operating surgeon performed more than 50 RGs within the study period.…”