Michael P Choi, MD1, Maureen Moore, MD1, Katherine Gray-Elmously, MD1, Omar Bellorin-Marin, MD2, Gregory Dakin, MD1, Alfons Pomp, MD1, Rasa Zarnegar, MD1, Cheguevara Afaneh, MD1. 1Weill Cornell Medicine – New York Presbyterian Hospital, 2Valley Medical Group
Introduction: The robotic platform offers several advantages for abdominal wall hernia repairs. Here, we describe our initial outcomes with various types of abdominal wall hernia operations performed using the da Vinci Xi® robot.
Materials and Procedures: Retrospective review of 204 patients who underwent robotic abdominal wall hernia repairs (rAWHR) between March 2015 to August 2017 at a single academic institution performed by two surgeons. Data examined included age, gender, body mass index (BMI), hernia type/size, American Society of Anesthesiologist (ASA) score, operative time, estimated blood loss (EBL), length of stay (LOS) and post-operative complications. All hernias were repaired with mesh. Inguinal hernias (including femoral) were repaired using a transabdominal preperitoneal (TAPP) technique. Ventral and incisional hernias were closed primarily and reinforced with preperitoneal, retrorectus or intraperitoneal onlay mesh.
Results: Most patients had ASA scores of 2 (54.2%) or 3 (33.9%). Inguinal hernia repairs (IHRs) comprised the majority (59.3%) of cases (71.9% male, mean age 55.5, mean BMI 26.2). There were 103 unilateral IHRs with an average operative time of 97.2 ± 55.5 min and an average EBL of 19.8 ml. There were 18 bilateral IHRs with an average operative time of 132.4 ± 49.9 min and average EBL of 19.8 ml. Thirteen IHRs were combined with umbilical hernias and two with incisional hernias. Average operative time for combined procedures was 152.8 min and average EBL was 29.7 ml.
Fifty-five incisional hernias were repaired robotically (56.3% male, mean age 54.5, mean BMI 28.9), four of which were retrorectus and two of those required transversus abdominis release. Median hernia size was 6 cm (2 – 13 cm). Mean operative time was 132.9 ± 57.4 min and average EBL was 31.5 ml. Twenty-three ventral/umbilical hernias were repaired robotically (52.2% male, mean age 45.4, mean BMI 28.8, median size 2.5 cm (1 – 4 cm), mean operative time 89.7 ± 29.5 min, average EBL 13.3 ml). One Spigelian hernia (operative time 99 min, EBL 20 ml) and one parastomal hernia (operative time 117 min, EBL 200 ml) were repaired robotically.
There were no major complications and only 1 groin seroma requiring percutaneous aspiration. Nine patients required > 24 hour LOS.
Conclusions: The da Vinci Xi® robot allows for multiquadrant surgery and facile intracorporeal suturing which is uniquely suited for AWHRs. The feasibility and safety of rAWHRs is similar to laparoscopic hernia surgery in terms of operative times, blood loss, LOS and complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88040
Program Number: P776
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster