Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience

Abstract

IntroductionTo describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes.Material and methods12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure.ResultsSac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data.ConclusionsRobot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.

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

“…In this setting, simultaneous repair of groin hernia can always be repaired quickly and easily. 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 …”

“…Laparoscopic groin hernia repairs are commonly carried out via two standard approaches, either trans‐abdominal pre‐peritoneal (TAPP) repair or total extra‐peritoneal (TEP) repair. In the robotic era, most of the reported robot‐assisted techniques were performed using the TAPP approach, except in very limited case reports of simultaneous TEP repair during a robot‐assisted radical prostatectomy . Although these two standardized laparoscopic approaches for groin hernia repair are comparable in their long‐term clinical outcomes, the TAPP approach was associated with more surgical complications and seroma formation than was the TEP approach in a large‐scale population‐based study …”

The Surgical Robot: Applications and Advantages in General Surgery

“…The Urology literature recognizes the relevance of the surgical robot when a TEP is performed at the time of robotic prostatectomy as a combined operation [87]. In the General Surgery literature, where the robotic TAPP approach is favored, the absence of neuralgia after the operation is likely a reflection of all of the advantages offered by the robotic platform in addition to the avoidance of tacks to fix the mesh and close the peritoneal flap, which is similar to the observation made in the ventral hernia series when tacks are avoided as well as transfascial sutures [88].…”

Strategy for laparoscopic repair of inguinal hernia after robot‐assisted radical prostatectomy

“…Robot‐assisted radical prostatectomy (RARP) for prostate cancer has recently become widespread and is now performed worldwide 1–4 . Although the safety of RARP has been established, the appearance of inguinal hernia (IH) after surgery is one of the late complications of the procedure.…”

“…Although the safety of RARP has been established, the appearance of inguinal hernia (IH) after surgery is one of the late complications of the procedure. Several studies have reported that patients undergoing RARP have a risk of 4%–20% for developing an IH following this procedure 4–6 . It is speculated that the dissection of the preperitoneal space during radical prostatectomy (RP) can cause contraction of the transversalis fascia, increasing the size of the internal ring and thus causing indirect IH 7 …”