Filip Muysoms, PhD1, Conrad Ballecer, MD2, Archana Ramaswamy, MD, MBA3. 1Maria Middelares, Ghent, Belgium, 2Center For Minimally Invasive And Robotic Surgery, Phoenix, Arizona, 3Department af Surgery, University of Minnesota, Minneapolis VA Medical Center, US
Background: Robotic assisted laparoscopic transabdominal preperitoneal inguinal hernia repair (rTAPP) is demonstrating rapid adoption in the United States. Barriers to adopting this innovative technique in Europe include: low availability of the robotic system to general surgeons, cost of robotic instruments and perception of longer operative time.
Methods: Patients undergoing rTAPP in our 12 month start-up period were entered in the prospective EuraHS database. Operations were performed with the DaVinci Xi by the same surgeon. Operative time is recorded as the time from incision to complete closure of skin, thus including docking time.
Results: Following proctoring on the use of the robotic system for this procedure in September 2016 by US surgeons, 125 rTAPP procedures have been performed up to September 2017. Of these, 76 were unilateral and 49 were bilateral repairs.
Mean operative time for unilateral hernias was 50 min (range: 27-103). For the first 25 unilateral hernias mean operative time was 57 min, compared with 50 min for the second 25 patients and 51 min for the last 26 patients. Mean operative time for bilateral hernias was 71 min (range: 38-118). For the first 25 bilateral hernias mean operative time was 80 min, compared with 62 min for the next 24 patients.
There were no conversions to conventional laparoscopy or open surgery. The operation was performed on an outpatient basis in 83 patients (66%), with overnight stay in 37 patients (30%) and extended stay in 5 patients (4%). Urinary retention requiring urinary catheterization was the main early postoperative complication noted in 6 patients (5%). At 4 weeks follow-up, 14 patients (6%) had a seroma, but no other complications were seen.
The same surgeon performed a consecutive series of 205 conventional laparoscopic TAPP operations prospectively recorded in the EuraHS database since March 2015. Mean operative times were 49 min (range: 24-104) and 65 min (range: 40-114) for 108 unilateral hernias and 97 bilateral hernias, respectively.
Conclusion: Robotic TAPP was associated with a rapid reduction in operative time during our learning curve with similar operative times compared to laparoscopic TAPP after 25 cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87347
Program Number: P048
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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