Thomas J Shaknovsky, DO1, Frederick L Sabido, MD, FACS2, Dooniya I Shaikh, MS2. 1Southeast Alabama Medical Center, 2Richmond University Medical Center
INTRODUCTION: This study aims to document our initial experience with robotic surgical approach to ventral hernias as part of our Advanced GI Minimally Invasive Surgery (MIS) fellowship curriculum. Over the course of 9 months we utilized the da Vinci robotic platform and performed 44 ventral hernia repairs using 4 different types of mesh. We describe our experience, results, and conclusions of using this novel approach.
METHODS AND PROCEDURES: All robotic ventral hernia repairs with mesh performed electively from July 2015 to March 2016 were tracked and retrospectively analyzed. Procedures were performed by MIS fellowship program director with active participation of the MIS Fellow and general surgical residents. Preoperative diagnosis included simple ventral hernias and chronically incarcerated ventral hernias. No acutely incarcerated or strangulated hernia repairs were included in this study. Age, ASA (American Society of Anesthesiologists), diagnosis, BMI, total operative time (docking and console time), and complications (death, recurrence, wound infection, conversion to laparoscopic/open procedure, chronic pain and re-admissions) were analyzed. All cases were performed using intraperitoneal only mesh (IPOM) and fascial defect size was measured intra-operatively. Hernia sac was always excised prior to completing the fascial repair and mesh was sutured to abdominal wall peritoneum using V-Loc 180 device and barbed monofilament. No tacks or trans-fascial sutures were employed. Patient follow up was at 1 and 12 weeks postoperatively.
RESULTS: Under aforementioned criteria, a total of 44 cases were performed. Patient population characteristics were: mean age 52 years (range 26-81), mean BMI 34 (range 20-53), mean ASA 2.2 (range 1-3) and mean total operative time of 161.5 min (range 78-350). Cohort diagnosis breakdown was 9 (20%) chronically incarcerated and 35 (80%) reducible ventral hernias. Fascial defect mean size was 5 cm (range 3 cm – 10 cm). Mesh types used were: Symbotex – 36(82%), Phasix ST 4(9%), Ventralex ST – 1(2%) and Ventrio ST – 1(2%). One (2%) patient developed a hematoma which was evacuated in the office and wound packed until complete healing occurred. There were no incidences of death, wound infection, conversion to laparoscopic/open procedure, re-admission, recurrence, or chronic pain.
CONCLUSIONS: Robotic ventral hernia repair is feasible and safe to perform on any patient regardless of diagnosis, BMI, age, and ASA at a teaching community medical center. Our data indicates that either type of mesh can be utilized. This approach has low morbidity and virtually eliminates the complication of chronic pain by avoiding trans-fascial sutures and tacks.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80310
Program Number: P593
Presentation Session: Poster (Non CME)
Presentation Type: Poster