Barbara Nguyen, MD1, Bryan David, MD1, Kensey Gosch, MS2, George B Sorensen, MD2. 1University of Missouri-Kansas City General Surgery, 2St. Luke’s Hospital
BACKGROUND: An increasingly multifaceted surgical population necessitates effective, safe, ventral hernia repairs. Approaches to complex hernias include advances in abdominal wall reconstruction, such as transverse abdominis release (TAR), and diverse operative technology to achieve this. While robotic assisted laparoscopic repair provides a minimally invasive approach to a maximally invasive surgery, the cost of utilizing this tool—and longer operative times—have argued against its use. As robotic surgery emerges as a major surgical instrument, an analysis of its outcomes, particularly examining perioperative, postoperative, and follow-up periods, can better clarify its role.
METHODS: A retrospective review was performed from September 2016 to February 2017 of patients undergoing TAR and sublay mesh placement. Various components of surgery, hospitalization, and outcomes were compared between patients receiving standard open repair (SOR) and those receiving robotic-assisted repair (RAR) using Student’s t-test or Wilcoxon Signed Rank test for continuous variables and Pearson’s Χ2 test for categorical variables.
RESULTS: Of the 43 patients reviewed, 16 were SOR, versus 27 RAR. Patients were comparable in age, gender, BMI, and number of diabetic patients. The average size of defect was similar between SOR and RAR groups (242 cm2 vs. 216 cm2 respectively, p=0.40). Perioperatively, RAR patients had longer operative times than OAR patients, at 272 minutes compared to 206 minutes (p<0.001). Estimated blood less (EBL) was less in the RAR group (43 mL) than OAR (147mL, p<0.001). Postoperatively, OAR patients averaged 9.6 hospital days, while RAR patients averaged 3.0 days (p<0.001). Half of the OAR patients and one RAR patient required critical care management during hospitalization. More RAR patients had seromas; none required surgical intervention. Both groups had four patients present to the emergency department within 30 days, with two in the OAR group readmitted.
CONCLUSIONS: Compared to SOR patients, RAR had a significantly shorter length of stay and less EBL. However, they also had longer operative times, which may be reflective of learning curves with robotic training and ongoing development of reconstruction techniques. More postoperative complications requiring critical care management and readmission were noted in the SOR group. While the robotic approach may require more operative time, shorter hospital length of stay with less postoperative complications would suggest its ultimate benefit in abdominal wall reconstruction, as it has less hospital costs, and provides better outcomes for patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95632
Program Number: P539
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster