Omar Y Kudsi, MD, MBA, FACS1, Partha Bhurtel, MD2, Georgios Orthopoulos, MD, PhD2, Jigesh Shah, DO2. 1Tufts University School of Medicine, Good Samaritan Medical Center, 2Tufts university School of Medicine, Saint Elizabeth Medical Ceter
Background: There is limited data on the value of a robotic approach for complex abdominal wall reconstruction and the ability to reproduce these results among surgeons. We describe our initial experience and present a foundation for further research in regards to the reproducibility of such approach including perioperative outcomes.
Methods: A single-center, retrospective review of prospectively collected data between 2015 and 2016 was performed on robotic retromuscular ventral hernia (RRVH) repair with approval from the institutional review board (IRB). We utilized social media platforms (international hernia collaboration and robotic surgery collaboration) for continuous mentorship. Data collected included patient demographics, details related to the surgical procedure (including defect size, mesh size and fixation), the ability and technique used to close the fascia (including the need for component separation), conversion rate to an open procedure, perioperative outcomes (surgical site occurrence, surgical site infection, hospital readmission, and early hernia recurrence due to technical error). Routine postoperative follow-up was at 2 weeks and 3 months.
Results: A total of 26 consecutive RRVH were performed utilizing the Intuitive Si daVinciTM robotic platform, including 9 transversus abdominus release (TAR) component separation repairs. All cases were considered elective with ASA scores ranging between 2-3. Demographics included: average BMI 33.7 (range 28-42), sex (male n=16, female n=10) and average age 61.3 years (range 42-82 years). All cases were classified as clean, with the exception of 1, where an iatrogenic colostomy was encountered and repaired primarily without spillage. Operative times averaged168 (range 72-242) for RRVH without TAR and 295 minutes (range 234-335) for RRVH with TAR (average operative time for all cases was 212 minutes (range 72-335 minutes). The average hernia defect was 89 cm2 (range 24-300 cm2), whereas the average size of synthetic mesh used was 550 cm2 (range 192-1400 cm2). Conversion to an open procedure was required in 1 case (3.8%) due to an inability to close the anterior fascia. Average blood loss was 10 mL (range 5-50 mL) and average hospital length of stay was 1.08 days (range 0-5 days). Complications consisted of n (=1) symptomatic seroma requiring aspiration. No surgical site infection, early hernia recurrence, or hospital readmission were encountered. All 26 patients were seen at 2 weeks and 3 months.
Conclusion: Our early experience has demonstrated that RRVH repair with or without component separation is a safe, feasible and reproducible approach, which allows the surgeon to perform complex abdominal wall reconstruction via a minimally invasive approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78821
Program Number: P062
Presentation Session: Poster (Non CME)
Presentation Type: Poster