Robotic-Assisted Hernia Repair: Does Avoiding the Tack Avoid the Pain?

Cheguevara Afaneh, MD, Brendan Finnerty, MD, Rasa Zarnegar, MD. New York-Presbyterian Hospital/Weill Cornell Medical College

INTRODUCTION: The versatility of the robotic platform in general surgery has led to its use in hernia surgery. We hypothesize that the technical advantages of the robotic platform for suture fixation of mesh, compared to conventional laparoscopy with tack fixation, may translate into shorter length of stay and decreased postoperative pain in patients undergoing ventral hernia repair.

METHODS: We retrospectively reviewed the initial nine consecutive patients undergoing robotic-assisted ventral hernia repair with mesh from June 2014 to September 2014 (Robotic-Assisted Group) by one surgeon (RZ). We compared these patients to a group of eleven patients who underwent laparoscopic-assisted ventral hernia repair during the same surgeon’s early experience with this technique (Early Laparoscopic Group) as well as the most recent ten consecutive patients who underwent laparoscopic-assisted ventral hernia repair prior to performing our first robotic ventral hernia repair (Late Laparoscopic Group). All hernias were either primary ventral hernias or incisional hernias. Our technique includes both primary repair of the defect as well as placement of an underlay mesh. Robotic-assisted hernia repairs involve robotically suturing the mesh in place, while the laparoscopic approach employs tack fixation of the mesh. Perioperative parameters were recorded and analyzed. Primary end-points included length of stay and early postoperative pain scores. Secondary end-points included postoperative complications.

RESULTS: There were no significant differences in preoperative variables between the three groups, except age (P=0.03) [Table]; however, there was no significant difference in age between the Robotic-Assisted Group and Early Laparoscopic Group (P=0.34). There was no significant difference between mesh area, estimated blood loss, length of stay, or early postoperative pain scores between all groups (P>0.05). However, operative time was highest in the Robotic-Assisted Group (P<0.0001). There were no intraoperative complications in any of the groups. There were no postoperative complications in the Robotic-Assisted Group and one each in the two laparoscopic groups (P>0.05). There was a significant and positive correlation between mesh area and operative time (r2=0.62; P=0.01) in the Robotic-Assisted Group [Figure].

CONCLUSIONS: Robotic-assisted ventral hernia repair with mesh is safe and feasible compared to the laparoscopic approach; however, operative times may be longer particularly for larger mesh placements. Nevertheless, this may still represent the learning curve to this novel technique. Moreover, a larger sample size is necessary to fully elucidate any potential benefit to this approach.

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