Robotic-assisted laparoscopic inguinal hernia repair after previous transabdominal prostatectomy

Abstract

Background Transabdominal prostatectomy results in scarring of the retropubic space and this might complicate subsequent preperitoneal dissection and mesh placement during minimally invasive inguinal hernia repair. Therefore, it suggested that an open anterior technique should be used rather than a minimally invasive posterior technique in these patients. Methods In this single-center study, a retrospective analysis of a prospectively maintained database was performed. All patients undergoing inguinal hernia repair after previous transabdominal prostatectomy were included in this analysis, and the feasibility, safety, and short-term outcomes of open and robotic-assisted laparoscopic inguinal hernia repair were compared. Results From 907 inguinal hernia operations performed between March 2015 and March 2020, 45 patients met the inclusion criteria. As the number of patients treated with conventional laparoscopy was very low (n = 2), their data were excluded from statistical analysis. An open anterior repair with mesh (Lichtenstein) was performed in 21 patients and a robotic-assisted laparoscopic posterior transabdominal repair (rTAPP) in 22. Patient characteristics between groups were comparable. A transurethral urinary catheter was placed during surgery in 17 patients, most often in the laparoscopic cases (15/22, 68.2%). In the rTAPP group, a higher proportion of patients was treated for a bilateral inguinal hernia (50%, vs 19% in the Lichtenstein group). There were no intraoperative complications and no conversions from laparoscopy to open surgery. No statistically significant differences between both groups were observed in the outcome parameters. At 4 weeks follow-up, more patients who underwent rTAPP had an asymptomatic seroma (22.7% vs 5% in the Lichtenstein group) and two patients were treated postoperatively for a urinary tract infection (4.7%). Conclusion A robotic-assisted laparoscopic approach to inguinal hernia after previous transabdominal prostatectomy seems safe and feasible and might offer specific advantages in the treatment of bilateral inguinal hernia repairs.

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

“…No data with regard to patients who had previous prostatectomies were reported in the included studies. Recent papers showed that the robotic platform with its improved dexterity and enhanced high-definition three-dimensional image may be particularly helpful in the challenging dissection of the retro-pubic space in patients who had prior prostatectomies [ 36 , 37 ]. Those advantages offered by the robotic platform may expand the indications for minimally invasive inguinal hernia repair also for those cases which, nowadays, are performed only by expert laparoscopic surgeons.…”

Laparoscopic Approach in the Treatment of Inguinal Hernias in Patients After Radical Prostatectomy: Comparison of Tarr and Ter Results

“…Возможность и безопасность применения минимально инвазивных методик лечения паховых грыж у пациентов с ранее перенесенными операциями на нижних отделах живота, в том числе после радикальной простатэктомии, занимала умы исследователей в течение длительного времени [16]. Результаты исследований, направленных на изучение данной проблемы, позволяют предположить безопасность эндоскопических методик герниопластики в руках высококвалифицированного специалиста, при этом TEP характеризуется относительно большей длительностью вмешательства по сравнению с ТАРР [17,18].…”

Robotic-assisted inguinal hernia repair: A historical review

“…Choosing the best technique for repairing an inguinal hernia is challenging because the available data is controversial. To date, numerous observational studies [5][6][7][8] and one randomized trial have failed to demonstrate that short-term and functional outcomes after robotic surgery are superior to those of laparoscopic surgery for patients with inguinal hernia. The aim of the review is to provide an overview about the current practice for inguinal hernia repair with the focus on robotic approach.…”