Anthony M Gonzalez, MD, FACS, FASMBS, Jorge R Rabaza, MD, FACS, FASMBS, Rupa Seetharamaiah, MD, FACS, Charan Donkor, MD, Rey Romero, MD, Radomir Kosanovic, MD, Francisco Perez-Loreto, MD, Jonathan Arad, MD
Baptist Health South Florida, Florida International University Herbert Wertheim College of Medicine
INTRODUCTION: Ventral Hernia Repair (VHR) is the second most common abdominal wall hernia repair, accounting for 25-30% of all the cases. Since LeBlanc first described the Laparoscopic Ventral Hernia Repair (LVHR), many others have reported on its effectiveness. However, this approach still has several limitations, including seromas, recurrences and advanced skill required. Recently a novel technology, robotic surgery, has emerged in different surgical areas, showing encouraging outcomes. The robotic surgery applied for the VHR could make the procedure technically easier, reduce complications and allow more accessibility to patients. Few papers have evaluated VHR using the robotic technology and no one has compared with the laparoscopic approach. The purpose of this study is to show our preliminary experience during RVHR and compare our results with our laparoscopic experience.
METHODS: We retrospectively collected, under IRB approval, data from our first 67 RVHR and our last 67 LVHR at our health system, during the period of June 2009 to August 2012. All the robotic procedures were performed using the daVinci® Surgical System. Primary closure of the facial defect was performed only in the robotic cases. Fixation of the mesh was performed with tacks and trans-facial stitches in LVHR and with tacks and intra-corporeal sutures in the RVHR.
RESULTS: Patients were female in 47 (70.1%) LVHR and in 41 (61.2%) RVHR (p=0.27), Mean age was 55 (±13.1) and 56.6 (±14.5) (p= 0.5). LVHR series had a mean ASA of 1.97 while in the RVHR series is was 2.15. Mean BMI was 33.1(±9.5) for laparoscopic cases and 34.6 (±8.9) for the robotic (p=0.31). The following types of ventral hernia were found: incisional [50(74.5%) vs 53(79.1%)], umbilical [5(7.5%) vs 7(10.4%)], epigastric [6(9%) vs 5(7.5%)] and others hernias [6(9%) vs 2(3%)] for LVHR and RVHR respectively (p= 0.47). For LVHR main surgical time was 88.3 min (range 23-279), and for RVHR was 107.6 min (range 61-198) (p=0.01). Total hospital length of stay was 3.6 days for LVHR and 2.5 day for RVHR. Mean follow up for LVHR was 21.7 months (range 0-38) and for RVHR was 16.5 months (range 0-33) (p=<0.01). Conversion to open surgery was seen in 2 LVHR and 1 RVHR. Nine (13.4%) complications and 5(7.4%) recurrences were observed in LVHR while 1(1.5%) complication and 2(2.9%) recurrences were seen for RVHR.
CONCLUSIONS: LRHR had lower surgical time, which is likely related to procedure and lack of closure of fascial defect. RVHR has superiority in terms of complication rate and recurrence. However, differences in this parameters could be influenced by difference in follow up and technical factors. Randomization is mandatory to corroborate these preliminary results.
Session: Poster Presentation
Program Number: P292
