David S Edelman, MD. Doctor’s Hospital, Coral Gables, Florida
Introduction: Laparoscopic inguinal hernia repair has certain advantages over open repair including less pain and an earlier return to normal activity. Concurrent robotic inguinal hernia repair at the time of prostatectomy has been shown to have a lower recurrence rate than open repair. Robotic surgery has improved high definition visualization and articulating instruments with enhanced dexterity which could improve outcomes. A series of robotic, laparoscopic inguinal hernia repairs with mesh is presented.
Methods: Three hundred thirty-five laparoscopic inguinal hernia repair operations were performed from April 2012 through August 2014. There have been 79 cases of robotic TAPP procedures done during that time. Hospital records and follow up care were reviewed. Hernias were sutured closed, re-inforced with a 12×15 cm PPM mesh and sealed with fibrin sealant.
Results: Age averaged 57.3 years (41-75 years). Ninety percent were male. Two patients had concomittant umbilical hernia repair with mesh. ASA class averaged 2.1 with co-morbidities of hypertension, hypercholesterolemia and GERD being the most common associated conditions. OR time ranged from 35-120 minutes with a average of 69.7 minutes. OR time has continued to decrease as experience has increased. One patient with a large scrotal hernia was converted to an open repair. There were no complications but one recurrence has been documented.
Conclusions: Robotic, laparoscopic inguinal hernia repair is safe and effective. OR times are longer than standard laparoscopic repair but has decreased with experience. With the increased use of robotics for hysterectomy and prostatectomy and the known presence of inguinal hernias, it is important that General Surgeons have the expertise to safely repair inguinal hernias with robotics.
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