Robotic‐assisted ventral hernia repair with surgical mesh: how I do it and case series of early experience

• Published in: ANZ journal of surgery Vol. 89; no. 3; pp. 248 - 254
• Main Authors: Kozman, Mathew A., Tonkin, Darren, Eteuati, Jimmy, Karatassas, Alex, McDonald, Christopher R.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-03-2019; Blackwell Publishing Ltd
• Subjects: Adult; Aged; Aged, 80 and over; Body mass; Body mass index; Body size; Complications; Docking; Early experience; Female; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - methods; Humans; Laparoscopy; Male; Middle Aged; New technology; Pain; Patients; Retrospective Studies; robotic; Robotic surgery; Robotic Surgical Procedures; Robotics; Surgical Mesh; Sutures; Treatment Outcome; ventral hernia; ventral hernia; surgical mesh; robotic
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15071

Background
Laparoscopic ventral hernia repair provides several benefits over the open approach. Intraperitoneal surgical mesh placement without fascial defect closure is associated with increased seroma formation and other adverse hernia‐site outcomes. Transfascial sutures and tacs for fascial closure and surgical mesh fixation are associated with greater post‐operative pain. Robotic‐assisted ventral hernia repair (rVHR) may afford benefits of the laparoscopic approach while facilitating a more robust and less painful repair.
Methods
Consecutive patients managed by rVHR from May 2015 to August 2018 were identified from a prospectively maintained robotic database. Retrospective review of this data was performed.
Results
Fifty patients underwent rVHR during the study period. Median body mass index was 31 (interquartile range (IQR) 29–34). Forty‐eight had previous abdominal surgery. Forty‐seven hernias were midline and three were lateral. Regarding hernia width, 15 were <4 cm wide, 32 were 4–10 cm and three were >10 cm. Median total anaesthetic time, docking time and surgical console time were 214 min (IQR 182–252), 5 min (IQR 4–8) and 144 min (IQR 104–174), respectively. No major intra‐operative complications occurred. No documented cases of adhesional complications or chronic post‐operative pain have occurred. To date, two recurrences have occurred in our series. Median length of hospital stay was 3 days (IQR 2–4).
Conclusion
We describe our rVHR technique and report on our series and early experience, showing that rVHR can be performed safely with good patient outcomes. We demonstrate a team approach to achieving a safe transition to new technology.
Robotic‐assisted ventral hernia repair (rVHR) may afford benefits of the laparoscopic approach while facilitating a more robust and less painful repair. We describe our rVHR technique and report on our series of 50 patients and early experience, showing that rVHR can be performed safely with good patient outcomes. We demonstrate a team approach to achieving a safe transition to new technology.