Omar Y Kudsi, MD, MBA, FACS1, Georgios Orthopoulos, MD, PhD2, Partha Bhurtel, MD2, Jigesh Shah, DO2. 1Tufts University School of Medicine, Good Samaritan Medical Center, 2Tufts University School of Medicine, Saint Elizabeth Medical Ceter
Background: To date, data on the use of mesh in the pre-peritoneal space between the posterior fascia and peritoneum in ventral hernia repair is limited. Here, we describe our initial experience and build a foundation for further research in regards to robotic trans-abdominal pre-peritoneal (rTAPP) ventral hernia repair.
Methods: A single-institution, retrospective review of prospectively collected data between 2014 and 2016 was performed on rTAPP ventral hernia repair with approval from the institutional review board (IRB). Data collected included patient demographics, operative details (including defect size, synthetic mesh size, and the ability to complete rTAPP), and postoperative complications during the first 90 days (surgical site occurrence, surgical site infection, hospital readmission, and hernia recurrence)
Results: 54 consecutive rTAPP ventral hernia repairs were performed utilizing the Intuitive Si daVinciTM robotic platform. With the exception of 2 emergent cases, all considered were elective with ASA scores ranging from 1-3. Indications included 42 primary ventral, 5 incisional, 2 lumbar, 2 spigelian, 1 recurrent incisional, 1 combined flank and inguinal and 1 combined primary ventral and inguinal. Demographics included: average BMI 32.1 (range 21-44), sex (male n=33, female n=21), and average age 50 years (range 22-78 years). Average operative time for all rTAPP cases was 73 minutes (range 25-217 minutes). The average hernia defect was 9.7 cm2 (range 2-80 cm2) whereas the average size of synthetic mesh used was 177.5 cm2 (range 81-450 cm2). 46 cases were completed through an rTAPP approach (85%) using non-composite mesh, whereas 9 were considered partial rTAPP due to inability to cover mesh completely thus a composite mesh was used. Average blood loss was only 5 mL (range 5-10 mL). Average hospital length of stay was 0 days (range 0-2 days). Complications included: symptomatic seroma requiring aspiration once in the office (n=1) and rectus sheath hematoma requiring hospital readmission and blood transfusion (n=1). No surgical site infection or hernia recurrence were encountered. All patients were seen at office for clinical evaluation at two weeks and three months follow-up.
Conclusion: Our early experience has demonstrated that robotic trans-abdominal pre-peritoneal ventral hernia repair (rTAPP) is a safe, feasible and reproducible approach for ventral hernia repair, allowing the surgeon to place mesh into the pre-peritoneal space utilizing a minimally invasive approach. Further studies aimed at assessing the clinical value of this approach are currently underway.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78822
Program Number: P047
Presentation Session: Poster (Non CME)
Presentation Type: Poster