David S Edelman, MD
Doctor’s Hospital, Coral Gables, Florida
Introduction: Laparoscopic inguinal hernia repair has certain advantages over open hernia repair including less pain and earlier return to normal activity. Concurrent robotic inguinal hernia repair at the time of prostatectomy has been found to have a lower recurrence than open repair. Robotic surgery has high definition visualization and articulating instruments with enhanced dexterity which could improve outcomes for hernia surgery. A series of robotic laparoscopic inguinal hernia repairs by a single surgeon with an extensive laparoscopic experience at a single institution was undertaken to determine if robotic laparoscopic inguinal hernia repair has a role in the future of minimal access surgery.
Methods: Eighty-five laparoscopic inguinal hernia operations were performed from May through August 2012. Ten of the initial cases of robotic TAPP procedures were matched to 10 laparoscopic TEP procedures done on the same days. Hospital records were retrospectively reviewed and data collected for age, sex, American Society of Anesthesia (ASA) class, operative time and post-op narcotic use. Operative time was measured from skin incision to skin closure.
Results: All patients were male except for one 58 year old woman done robotically. Age averaged 57.8 years, range of 41-75, for the robot compared to 56.9 years, range of 43-84, in TEP. The robotic cases included 3 bilateral, 1 bilateral recurrent, 3 right, 1 recurrent right and 2 left hernias. One patient with bilateral hernias had an umbilical hernia repair done concomitantly. The TEP arm included 5 right, 4 left and 1 bilateral hernia with an umbilical hernia repair. ASA was 1.88 for both groups with similar co-morbidities of hypertension, hypercholesterolemia and GERD. OR time ranged from 50-120 minutes with an average of 85.6 minutes for the robot. Times decreased as experience increased. OR time for the TEP averaged 34.4 minutes. Hydromorphone was administered intravenously in the recovery room totaling 0.4 to 1.6 mg along with 30 mg of ketorolac for the robot but only 0.2 to 0.4 mg with ketorolac for TEP. There were no complications in either group.
Conclusion: Robotic inguinal hernia repair is safe and compares favorably to laparoscopic TEP. OR time was longer but decreased with experience. There was slightly more intravenous narcotic use in the peri-operative period for the robotic cases. Further prospective studies are necessary to determine if this preliminary data is significant.
Session: Poster Presentation
Program Number: P274