Single- Site Robotic Assisted Inguinal Hernia Repair

Hiba Abdel-Aziz, MD, FACS, MCCM, Elisha A Chance, BSAS, CCRC. St Elizabeth Youngstown Hospital

Laparoscopic inguinal hernia repair is widely accepted and has certain advantages over open repair, including less post-operative pain and earlier return to normal activity. Robotic-assisted surgery provides surgeons with improved three-dimensional visualization and enhanced dexterity with articulating instrumentation. The aim of this study was to show that a robotic single-site gel port, regularly used for cholecystectomy, can be used for unilateral inguinal hernia repair and that robotic single-site instruments can be used efficiently and safely to perform dissection in inguinal hernia repairs. Patients were included if they were older than 18 years, had BMI < 35, and were undergoing surgical inguinal hernia repair. Patients were excluded if they had a history of any abdominal surgery or had serious medical conditions (ASA III or higher). The Da Vinci robot (Intuitive Surgical, Sunnyvale, CA, USA) was used for the hernia repairs. With the patient in supine position, a 2.5 cm incision was made within the umbilicus. The fascia was incised and the peritoneal cavity was entered. A single-site robotic cholecystectomy gel port (Intuitive Surgical, Sunnyvale, CA, USA) was inserted and the cavity was insufflated to 15 mmHg. Robotic instruments were inserted and the Robot was docked. Dissection began by raising a preperitoneal flap on the affected side using the single-site robotic Maryland, scissors, and hook (Intuitive Surgical, Sunnyvale, CA, USA) interchangeably. The hernia sac was identified and reduced then mesh was placed over the hernia and tacked in place. Finally, the preperitoneal flap was tacked back in place. The Robot was undocked, the abdomen was desufflated, and the fascia was closed. Single port unilateral inguinal hernia repair was safely and successfully performed for 6 patients. The first patient’s procedure was 2 hours long and the length of the procedure time decreased to 30 minutes for the sixth patient. All patients were discharged on the same day of surgery, had minimal pain, good aesthetic result, and no complications. Robotic single-site gel port inguinal hernia repair is as safe and time efficient as laparoscopic inguinal hernia repair with superior cosmetic results and less pain in this group of patients.

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