Robotic-assisted ventral and incisional hernia repair with hernia defect closure and intraperitoneal onlay mesh (IPOM) experience

Fuenmayor, Pedro; Lujan, Henry; Plasencia, Gustavo; Karmaker, Avik; Mata, Wilmer; Vecin, Nicole

doi:10.1007/s11701-019-01040-y

Cited by 13 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From 2012 to 2018, use of the robot for general surgery procedures increased from 1.8% to 15.1% . Commonly, robotic inguinal repair and intraperitoneal mesh placement for ventral hernias are regarded as basic procedures that the surgeons should be comfortable with before pursuing advanced techniques . Having completed 2 randomized clinical trials that failed to show a measurable benefit of these procedures, an alternative argument could be made that the robotic outcomes are comparable, safe, and allow surgeons to gain comfort with the robotic platform while working toward more complex approaches.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Despite rapid adoption of the robotic platform for ventral hernia repair with intraperitoneal mesh in the United States, there is no level I evidence comparing it with the traditional laparoscopic approach. This randomized clinical trial sought to demonstrate a clinical benefit to the robotic approach.OBJECTIVE To determine whether robotic approach to ventral hernia repair with intraperitoneal mesh would result in less postoperative pain. DESIGN, SETTING, AND PARTICIPANTSA registry-based, single-blinded, prospective randomized clinical trial at the Cleveland Clinic Center for Abdominal Core Health, Cleveland, Ohio, completed between September 2017 and January 2020, with a minimum follow-up duration of 30 days. Two surgeons at 1 academic tertiary care hospital. Patients with primary or incisional midline ventral hernias of an anticipated width of 7 cm or less presenting in the elective setting and able to tolerate a minimally invasive repair.INTERVENTIONS Patients were randomized to a standardized laparoscopic or robotic ventral hernia repair with fascial closure and intraperitoneal mesh. MAIN OUTCOMES AND MEASURESThe trial was powered to detect a 30% difference in the Numerical Rating Scale (NRS-11) on the first postoperative day. Secondary end points included the Patient-Reported Outcomes Measurement Information System Pain Intensity short form (3a), hernia-specific quality of life, operative time, wound morbidity, recurrence, length of stay, and cost. RESULTSSeventy-five patients completed their minimally invasive hernia repair: 36 laparoscopic and 39 robotic. Baseline demographics and hernia characteristics were comparable. Robotic operations had a longer median operative time (146 vs 94 minutes; P < .001). There were 2 visceral injuries in each cohort but no full-thickness enterotomies or unplanned reoperations. There were no significant differences in NRS-11 scores preoperatively or on postoperative days 0, 1, 7, or 30. Specifically, median NRS-11 scores on the first postoperative day were the same (5 vs 5; P = .61). Likewise, postoperative Patient-Reported Outcomes Measurement Information System 3a and hernia-specific quality-of-life scores, as well as length of stay and complication rates, were similar. The robotic platform adds cost (total cost ratio, 1.13 vs 0.97; P = .03), driven by the cost of additional operating room time (1.25 vs 0.85; P < .001).CONCLUSIONS AND RELEVANCE Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh have comparable outcomes. The increased operative time and proportional cost of the robotic approach are not offset by a measurable clinical benefit.

show abstract

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

et al. 2020

View full text Add to dashboard Cite

show abstract

“…One key contributing factor has been the use of barbed suture to allow for progressive intracorporeal approximation of the tissue. One small single-center study showed the feasibility of robotic ventral hernia defect closure using an intraperitoneal onlay mesh technique with recurrence rates similar to laparoscopic rates 24. Currently, barbed suture is being studied in other surgical specialties and in laparoscopic inguinal hernia repair with very promising results.…”

Section: Discussionmentioning

confidence: 98%

“…One small single-center study showed the feasibility of robotic ventral hernia defect closure using an intraperitoneal onlay mesh technique with recurrence rates similar to laparoscopic rates. 24 Currently, barbed suture is being studied in other surgical specialties and in laparoscopic inguinal hernia repair with very promising results. This study found that the closure of fascial defects using barbed suture in rVHR to be a safe and effective option.…”

Section: Discussionmentioning

confidence: 99%

Hernia Defect Closure With Barbed Suture: An Assessment of Patient-reported Outcomes in Extraperitoneal Robotic Ventral Hernia Repair

Tagerman

Pereira

Lima

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Primary closure of a fascial defect during ventral hernia repair is associated with lower rates of recurrence and better patient satisfaction compared with bridging repairs. Robotic surgery offers enhanced ability to close these defects and this has likely been aided by the use of barbed suture. The goal of this study was to evaluate the perioperative safety and the long-term outcomes for the use of barbed suture for the primary closure of hernia defects during robotic ventral hernia repair (rVHR) with mesh. Methods: This is a retrospective study of adult patients who underwent rVHR with the use of a barbed suture for fascial defect closure from August 2018 to August 2020 in an academic center. All the patients included were queried by phone to complete a quality of life assessment to assess patient-reported outcomes (PROs). Subjective sense of a bulge and pain at the previous hernia site has been shown to correlate with hernia recurrence. These questions were used in conjunction with a Hernia-related Quality of Life Survey (HerQles) score to assess a patient’s quality of life. Results: A total of 81 patients with 102 hernias were analyzed. Sixty patients (74%) were successfully reached and completed the PRO form at median postoperative day 356 (range: 43 to 818). Eight patients (13% of patients with PRO data) claimed to have both a bulge and pain at their previous hernia site, concerning for possible recurrence. Median overall HerQLes score was 82 [Interquartile Range (IQR): 54 to 99]. Patients with a single hernia defect, when compared with those with multiple defects, had a lower rate of both a bulge (15% vs. 30%) and symptoms (33% vs. 48%), as well as a higher median HerQLes score (85 vs. 62) at the time of PRO follow-up. Patients with previous hernia repair had a lower median HerQLes score of 65 (IQR: 43 to 90) versus 88 (IQR: 62–100). These patients also had a higher rate of sensing a bulge (29% vs. 18%), whereas a sense of symptoms at the site was less (33% vs. 44%). Conclusions: Barbed suture for fascial defect closure in rVHR was found to be safe with an acceptable rate of possible recurrence by the use of PRO data. Patients with multiple hernias and previous repairs had a higher likelihood of recurrence and a lower quality of life after rVHR.

show abstract

“…Furthermore, a systematic review from John Hopkins University concluded that underlay or retrorectus mesh placements are associated with lower recurrence rates, with the lowest seroma rates observed following a retrorectus repair [81]. Additionally, a study on robotic ventral/incisional hernia repair with hernia defect closure and intraperitoneal onlay mesh showed a hernia recurrence rate of 14.81% [82]. Therefore, while the choice of technique depends on various factors, including patient-specific circumstances and the surgeon's expertise, retromuscular or underlay mesh placements are generally associated with lower hernia recurrence rates [82].…”

Section: Applications On Trunk and Spinal Reconstructionmentioning

confidence: 99%

Skin Substitutes: Filling the Gap in the Reconstructive Algorithm

Fuenmayor,

Huaman,

Maita

et al. 2024

Trauma Care

Self Cite

View full text Add to dashboard Cite

Background: Skin substitutes play a crucial role in wound care by actively modulating the wound healing process, promoting angiogenesis, and protecting the integrity of the native extracellular matrix. Consequently, surgeons have increasingly recognized these resources as excellent complements to improve reconstructive outcomes. This review focuses on the author’s experience using these biomaterials in complex cases, highlighting the benefits they bring to patient care. Methods: A literature review was conducted to evaluate the regenerative properties of skin substitutes and their applicability in head and neck, upper and lower extremities, and trunk reconstruction. Results: The reviewed literature, along with the authors’ experience, supports the adjunct use of skin substitutes in various reconstructive situations. Combining them with skin grafts improves resulting skin quality and may also enhance donor site healing. They have proven to be effective in addressing chronic venous ulcers, traumatic wounds with limited donor tissues for coverage, extensive burns, diabetic foot ulcers, and oncological resections in the face and scalp. Furthermore, combining them with autologous tissue shows promising results in achieving stable closure. Conclusions: Incorporating skin substitutes in complex reconstructive scenarios offers multiple benefits. Their regenerative properties and ability to modulate the healing process contribute to enhanced outcomes and reduced overall costs.

show abstract

Robotic-assisted ventral and incisional hernia repair with hernia defect closure and intraperitoneal onlay mesh (IPOM) experience

Cited by 13 publications

References 16 publications

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh

Hernia Defect Closure With Barbed Suture: An Assessment of Patient-reported Outcomes in Extraperitoneal Robotic Ventral Hernia Repair

Skin Substitutes: Filling the Gap in the Reconstructive Algorithm

Contact Info

Product

Resources

About