Moska Hamidi, MD, MPH, FRCSC1, Jensen Tan, MD, MSc, FRCSC2, Lazar Klein, MD, MSc, FRCSC2, Steven Maclellan, MD, FRCSC2. 1Department of Surgery, St. Michael’s Hospital, 2Department of Surgery, Humber River Hospital
Background:Minimally invasive ventral hernia repair is increasingly prevalent in Canada;however, the uptake of robotic assisted ventral hernia repair (RAVHR) has been slow compared to other countries.The open approach continues to be widely used for complex hernia repairs requiring components separation,despite a lower incidence of SSI and comparable recurrence rates with a minimally invasive repair.Given the reported success of RAVHR as a minimally invasive approach to these hernias, we sought to determine the feasibility of its routine use in a community hospital setting.There is currently no other Canadian experience reported on RAVHR.This report describes our initial series.
Methods:We included all RAVHR performed at our institution, between Nov 2017-July 2018.We reviewed 30-day complications,mortality, LOS, opiates prescribed and operating time. A two-way scatter plot was used to describe the relationship between hernia size,number of cases performed and operating times.
Results:Eighteen patients from our institution performed by two robotic surgeons were analyzed.Mean follow-up period was 57 days.The mean age of our patients was 56 years (31-79),with the majority being male (n=12; 67%).All patients had an attempted RAVHR, with one patient (6%) requiring a conventional laparoscopic repair.The average BMI was 30.13 (22.9-37).The mean defect size was 5.4cm in maximal transverse diameter (2.5-15 cm)and all hernia defects were closed primarily.Fourteen patients (78%) received a retrorectus mesh repair and 3 patients (16.7%) received a component separation.The mean length of stay (LOS) was 1.28 days.The mean number of opiates prescribed at discharge was 16 tablets of Morphine 5 mg equivalents.There was one bowel injury (6%),and one paralytic ileus (6%) in the same patient.There were no readmissions or mortalities. One patient developed an abscess at the umbilicus.The mean operating time was 223 minutes (118-516 min);there was no significant change in operating time with increasing experience,as the hernia size varied, and sample size is limited. Pearson coefficient demonstrate the relationship between the hernia size and operating time, with a correlation of 0.65 (Figure 1).
Conclusion: The outcomes from our first series of RAVHR are consistent with previously published studies with respect to LOS and complication rates.Outcomes are also encouraging for using RAVHR for larger hernias requiring components separation.We have demonstrated the safety of this approach in a Community hospital setting in Canada.Our future study will assess the safety and cost-effectiveness of this approach in complex abdominal wall reconstruction with component separation as an alternative to open surgery in select populations.
Figure 1-Pearson Correlation Hernia Size vs. OR time
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95585
Program Number: P653
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster