Robot-assisted Treatment of Epigastric Hernias With a Suprapubic Approach

Abstract

Background: Robot-assisted ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are placed laterally to meet the distance from the fascial defect. The aim of our study is to report our experience of epigastric hernia treatment with trocar insertion in the suprapubic region.Materials and Methods: On a prospectively collected dataset on robot-assisted surgery, patients treated for epigastric hernias with suprapubic approach were identified. Demographic and clinical data were collected and analyzed.Results: Twelve patients were selected. Median age was 58.5 years [interquartile range (IQR): 47.8 to 67.3 y]; 4 patients were male (33.3%) and the median body mass index was 23.9 kg/m 2 (IQR: 22.3 to 26.2 kg/m 2 ). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR: 13.75 to 31.0 mm); median larger mesh diameter was 13.5 cm (IQR: 9.5 to 15.0 cm); and median operative time was 136.5 minutes (IQR: 120.0 to 186.5 min). No intraoperative complication or conversion to open surgery occurred. Postoperatively, 2 patients presented a seroma and median length of hospital stay was 2.0 days (IQR: 1.75 to 3 d). No case of hernia recurrence was recorded at a mean followup of 11.2 months (range: 4 to 29 mo).Conclusions: In the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one to have a better field overview, especially in subxiphoid hernias. Further studies are needed to assess the benefits and limitations of such technique.

Safety and feasibility of emergency robot‐assisted transabdominal preperitoneal repair for the treatment of incarcerated inguinal hernia: A retrospective study

“…Since its introduction into practice, robotic surgery has been applied across a broad range of elective surgical procedures. 8,10 However, robotic-assisted surgery in emergency setting has not been routinely performed and remains, to date, poorly investigated. 4,15 In a recent review, de'Angelis et al found 10 studies (5 cohort studies, 5 case reports) investigating the use of robot-assisted surgery in emergency general surgery.…”

“…According to a previous study of ours, an experienced laparoscopic general surgeon requires about 43 R-TAPP to achieve the learning curve. 8 Our robotic operative room is equipped with the Da Vinci Xi dual console, which enables teaching in a quiet and efficient environment and gradually exposes trainees with different level of competence to robotic surgery. 15 Our surgical team undergoes ongoing training aimed at refining their proficiency in utilizing this technology, applicable not only to elective cases but also emergent scenarios.…”

“…Since its introduction into practice, robotic surgery has been applied across a broad range of elective surgical procedures 8,10 . However, robotic‐assisted surgery in emergency setting has not been routinely performed and remains, to date, poorly investigated 4,15 .…”

“…The surgical technique for R-TAPP and for the open repair was already described in previous publications of our research group. [7][8][9][10] In the emergency setting, the operating theater setup was identical to that of elective surgery. The only peculiarity encountered was the reduction of the hernia content, necessitating specific attention while employing robotic assistance.…”

“…The surgical technique for R‐TAPP and for the open repair was already described in previous publications of our research group 7–10 . In the emergency setting, the operating theater setup was identical to that of elective surgery.…”