Robotic Assisted Ventral hernia Repairs: Technical Description, Short term outcomes

Rama Rao Ganga, Yaniv Cozacov, Meenakshi Rajan, Brett Cohen, Jeremy Gallego-Eckstein. Memorial Regional Hospital

Introduction: Ventral hernia repair remains to be a difficult problem despite advances in technology and surgical technique. Open repair is limited by wound infection, seroma formation in addition to high recurrence. Laparoscopic repair provided an alternative method where the wound infection, seroma formation is low although recurrence rate remains the same. However its main limitation remains significant pain after the procedure due to transfascial sutures lasting up to 8 months. Introduction of Robots facilitates avoidance of transfascial sutures by allowing difficult suturing of mesh to inner layers of abdominal wall. Main criticism of robotic surgery is that it is expensive. We differ with that perception and provide our experience to support the argument.
Objective: We report short term outcomes of robotic assisted ventral hernia repairs (Primary, incisional and recurrent) and compare the length of stay and costs with laparoscopic repair.
Materials & Methods: All the robotic assisted (RAR) and laparoscopic ventral hernia (LR) repairs performed during a 16 month period between April 2013 and August 2014 are studied retrospectively. Laparoscopic or Robotic hernia repair was chosen based on the patient, hernia characteristics. All robotic hernia repairs are performed with sac excision, primary closure of the defect and intra corporeal suturing of mesh to posterior rectus sheath without tackers or transfascial sutures. Demographic characteristics, Hernia characteristics, Mesh size, length of stay, reasons for hospital stay, complications, follow up and recurrences were compared between laparoscopic and robotic groups.
Results: Total of 20 Robotic assisted and 29 Laparoscopic ventral hernia repairs were performed over 16 month period. Mean age was much smaller in RAR at 45 yrs versus 60 (p=0.0002) in LR group, However BMI was similar in both groups (p=0.64). Mortality was 0% for both groups, Morbidity was higher in LR group (3 Vs 0 in RAR). Length of stay was significantly shorter in RAR group (0.7 days Vs 4.3, p value 0.003). RAR was also cheaper by $ 700 per each case without including mesh costs. Additionally a trend towards decreased complication rate was noted with RAR.

Conclusions: Length of stay is shorter in the postoperative period reflecting less post-operative pain. Robotic assisted ventral hernia repairs are cost effective or cheaper compared to laparoscopic repair.

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