Luis A Martin-del-Campo1, Adam S Weltz2, Igor Belyansky2, Yuri W Novitsky1. 1University Hospitals Cleveland Medical Center, 2Anne Arundel Medical Center
INTRODUCTION: Transversus abdominis release (TAR) has emerged as an effective approach to complex abdominal wall reconstructions (AWR). However, despite durable repair the open TAR has traditionally been associated with perioperative wound morbidity and relatively lengthy hospitalizations. Although utilization of robotics in AWR via TAR has already been described, its benefits over open technique have not been established well. We hypothesized that application of robotics to TAR when compared to the traditional open repairs will result in decreased wound complications and shortened convalescence.
METHODS: Case-matched comparison of consecutive patients undergoing robotic TAR (R-TAR) at 2 specialized Hernia centers to the historic cohort of Open TAR (O-TAR) patients. Outcome measures included patient demographics, operative details, postoperative complications, length of hospitalization, and hospital chargers.
RESULTS: Between April and August of 2016, 25 consecutive patients undergoing R-TAR were compared to 50 matched O-TAR patients from 2014-2015. There was no difference between the groups in patient sex, age, and Body Mass Index. The average defect side was 15.2 cm in the O-TAR group and 13.1 in the R-TAR group, p=0.09. The average operative time was significantly longer in the R-TAR group (324±22 vs 248±85 min, p=0.02). There were no intra-operative complications in either group. Postoperative hospitalization was significantly shorter in the R-TAR group (5.3 vs 1.4 days, p=0.01). Thirty-day wound events were significantly more frequent in the O-TAR group (17.4% vs 0%, p=0.02). There were 2 readmissions in the O-TAR group only. Although direct costs were significantly higher in the R-TAR group (+$712/case), indirect costs were significantly lower (-$4,439/case).
CONCLUSION: The use of robotics in complex AWR is evolving. In our early experience, robotic TAR was associated with longer operative times. However, we found that the use of robotics allowed for significantly shorter hospitalizations, lowered wound complications and decreased overall costs. While long-term outcomes of robotic TAR repair are under investigations, we believe the use of robotics in complex AWR may be beneficial in select patients with possible decrease in overall cost of complex hernia care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80473
Program Number: S107
Presentation Session: Hernias: Inguinal and Robotics
Presentation Type: Podium