Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes

BackgroundThe open approach continues to be widely performed for ventral hernia repair, while the minimally invasive laparoscopic approach has grown adoption over the last decade. Recently, robotic operation was described as a new modality due to the ease for performing intracorporeal closure of the hernia defect. This study is one of the first multi-institutional case series evaluating robotic-assisted laparoscopic ventral hernia repairs, with the goal of describing robotic-assisted surgical techniques for ventral and incisional hernia repair and the outcomes in teaching and community hospital settings.MethodsMedical records of consecutive patients (including surgeon’s learning curve cases) who underwent ventral or incisional hernia repair utilizing the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale CA) were retrospectively reviewed. Data collected included preoperative history and perioperative outcomes.ResultsData for a total of 368 patients from four institutions involving five surgeons were analyzed. They were predominantly females (60.3 %), and the mean age was 51 years. The majority of the patients were obese or morbidly obese (47.8 and 20.9 %), and 83.2 % of the patients had a history of prior abdominal operation. Conversion rate was 0.8 %, and mean length of stay was 1 day. Total postoperative complications rate up to 30 days was 8.4 %, of which incidence of paralytic ileus was 2.4 %.ConclusionThis large case series of 368 patients demonstrates reproducibility of safety and performance associated with robotic-assisted ventral hernia repairs performed by five surgeons at four institutions. In addition, the results of short term perioperative outcomes for surgeons during their early experience for robotic-assisted cases are in the range of what is reported in the existing published data on laparoscopic and open ventral hernia repairs. Further comparative evidence initiatives are being pursued to determine the benefits of robotic-assisted technique and technology for long-term and patient-reported outcomes.

[1]  L. Bencini,et al.  Incisional hernia: repair retrospective comparison of laparoscopic and open techniques. , 2003, Surgical endoscopy.

[2]  Garth H Ballantyne,et al.  The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. , 2003, The Surgical clinics of North America.

[3]  J. Glass,et al.  Laparoscopic ventral and incisional hernia repair: An 11-year experience , 2004, Hernia.

[4]  K. LeBlanc.  Incisional Hernia Repair: Laparoscopic Techniques , 2005, World journal of surgery.

[5]  U. Klinge,et al.  Incisional Hernia: Open Techniques , 2005, World Journal of Surgery.

[6]  Brent D. Matthews,et al.  Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual , 2007, Surgical Endoscopy.

[7]  A. Darzi,et al.  Outcomes Following Laparoscopic Versus Open Repair of Incisional Hernia , 2006, World journal of surgery.

[8]  G. Campanelli,et al.  Classification of primary and incisional abdominal wall hernias , 2009, Hernia.

[9]  C. Hwang,et al.  Laparoscopic ventral hernia repair is safer than open repair: analysis of the NSQIP data. , 2009, The Journal of surgical research.

[10]  A. Duckworth,et al.  Pseudo-recurrence following laparoscopic ventral and incisional hernia repair , 2010, Hernia.

[11]  Bulging of the Mesh After Laparoscopic Repair of Ventral and Incisional Hernias , 2010, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[12]  Y. Novitsky,et al.  Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique , 2011, Surgical Endoscopy.

[13]  D. Reda,et al.  Comparison of laparoscopic and open repair with mesh for the treatment of ventral incisional hernia: a randomized trial. , 2010, Archives of surgery.

[14]  A. Pigazzi,et al.  Technical Feasibility of Robot-Assisted Ventral Hernia Repair , 2012, World Journal of Surgery.

[15]  T. Berne,et al.  Laparoscopic Versus Open Anterior Abdominal Wall Hernia Repair: 30-Day Morbidity and Mortality using the ACS-NSQIP Database , 2011, Annals of surgery.

[16]  E. Tezel,et al.  Comparison of Laparoscopic Primary and Open Primary Repair of Ventral Hernias , 2011, Surgical laparoscopy, endoscopy & percutaneous techniques.

[17]  M. Liang,et al.  Laparoscopic Transcutaneous Closure of Central Defects in Laparoscopic Incisional Hernia Repair , 2012, Surgical laparoscopy, endoscopy & percutaneous techniques.

[18]  B. Todd Heniford,et al.  Laparoscopic versus open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample , 2012, Surgical Endoscopy.

[19]  S. Leichtle,et al.  Postoperative surgical site infections after ventral/incisional hernia repair: a comparison of open and laparoscopic outcomes , 2013, Surgical Endoscopy.

[20]  W. Hop,et al.  Laparoscopic vs. open incisional hernia repair: a randomized clinical trial. , 2013, JAMA surgery.

[21]  A. McCluney,et al.  Laparoscopic vs open ventral hernia repair in the era of obesity. , 2013, JAMA surgery.

[22]  T. Trus,et al.  Ventral hernia repairs in the oldest-old: high-risk regardless of approach , 2014, Surgical Endoscopy.

[23]  S. Hicks,et al.  Recurrence and Pseudorecurrence after Laparoscopic Ventral Hernia Repair: Predictors and Patient-focused Outcomes , 2014, The American surgeon.

[24]  M. T. Nguyen,et al.  Primary Fascial Closure With Laparoscopic Ventral Hernia Repair: Systematic Review , 2014, World Journal of Surgery.

[25]  G. Silecchia,et al.  Laparoscopic ventral/incisional hernia repair: updated Consensus Development Conference based guidelines [corrected]. , 2015, Surgical endoscopy.

[26]  K. Simmons,et al.  Laparoscopic versus open ventral hernia repair: longitudinal outcomes and cost analysis using statewide claims data , 2016, Surgical Endoscopy.

[27]  G. Silecchia,et al.  Laparoscopic ventral/incisional hernia repair: updated guidelines from the EAES and EHS endorsed Consensus Development Conference , 2015, Surgical Endoscopy.

[28]  A. Gonzalez,et al.  Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology , 2015, The international journal of medical robotics + computer assisted surgery : MRCAS.

[29]  M. Franz,et al.  Evolution and advances in laparoscopic ventral and incisional hernia repair. , 2015, World journal of gastrointestinal surgery.

[30]  J. Madura,et al.  Modified retrorectus ventral hernia repair. , 2016, American journal of surgery.