Jose E Escobar Dominguez, MD, Rupa Seetharamaiah, MD, Charan Donkor, MD, Jorge Rabaza, MD, FACS, Anthony M Gonzalez, MD, FACS, FASMBS. Baptist Health South Florida
INTRODUCTION – As the discipline of laparoscopic surgery has grown technology has been developed to facilitate the performance of minimally invasive hernia repair. The current Guidelines for laparoscopic (TAPP) and Endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)] published in 2011 draw important conclusions about many points of interest in the management of laparoscopic hernia repair. Since the development of robotic inguinal hernia is recent, it is not surprising that these guidelines do not mention it. Most of the published literature regarding robotic inguinal hernia repair has been performed by urologists who have dealt with this entity in a concomitant way during radical prostatectomies. General surgeons, who perform the vast majority of inguinal herniorrhaphies worldwide, have yet to describe the role of robotic inguinal hernia repair.
METHODS – A retrospective chart review was performed on patients who had a robotic inguinal hernia repair from January 2014 to August 2014 at Baptist Health South Florida. Patient demographics, past medical history, previous surgeries and details related to the surgical procedure were collected. In addition, perioperative outcomes and complications were noted. The reason the robotic approach was selected for each patient was documented.
RESULTS – A total of 51 hernias were repaired in 29 patients who underwent robotic TAPP inguinal hernia repair with a prosthetic mesh using the daVinci platform (Intuitive Surgical Inc). Among them 22 had bilateral robotic herniorrhaphies. The mean age was 59.83 (SD 14.94), with a BMI of 25.84 (SD 5.38). There were 28 male patients and 1 female. Previous medical history consisted of Hypertension in 18 patients, arrhythmia in 3, and chronic renal insufficiency in 2 . The primary reason for robotic approach was previous abdominal surgery in 9 cases (31.03%), recurrent inguinal hernia in 6 cases (20.7%), incarcerated hernia in 4 cases (13.79%), obstetric/gynecological surgery in 1 case (3.45%), and surgeon’s choice in 9 cases (31.03%). The mean surgical time was 102.55 min (SD 36.47 min). Perioperative surgical complications included hematoma in 2 patients (6.9%), 1 seroma (3.45%), 1 urinary retention (3.45%) and 1 surgical site infection (3.45%), which resolved with oral antibiotics. Chronic postoperative complications included the persistence of hematomas in 2 patients (6.9%). Same day discharge was achieved in 23 patients (79%) with a mean length of stay of 8:39 h (SD 1:55 h). Neither mortality nor conversion to open surgery occurred. No recurrences were noted in the first 30 day post operative period.
CONCLUSIONS – This early experience has demonstrated that the Robotic Transabdominal Preperitoneal (TAPP) inguinal hernia repair is a safe and versatile approach that allows the general surgeon to perform this procedure in challenging surgical scenarios. Large prospective randomized trials are needed to compare this approach to other minimally invasive choices for inguinal hernia repair.