Hernia Repair: Robot or No Robot?

Abstract

The utilization of minimally invasive techniques to repair hernias has continued to rise, and with the increasing use of the da Vinci robotic surgical system in general surgery, new methods have begun to emerge to repair abdominal wall hernias robotically. The use of the da Vinci robotic surgical system to repair inguinal hernias can achieve clinical results similar to traditional laparoscopy but with additional cost and operative time. A robotic inguinal hernia repair can be considered in situations where a laparoscopic transabdominal pre-peritoneal approach is necessary but prior surgeon experience with laparoscopic transabdominal pre-peritoneal approach is limited. Robotic ventral hernia repair offers a wide variety of repair techniques, many of which have been previously accomplished via traditional laparoscopy including robotic intraperitoneal onlay mesh, robotic pre-peritoneal, robotic retrorectus and transversus abdominis release, and robotic extended total extraperitoneal. Robotic equivalent techniques can typically accomplish increased fascial closure rates while avoiding transfascial sutures. More research needs to be conducted on the clinical benefits of increased fascial closure rates, but some studies point to a possible reduction in recurrence rates. Currently, the most promising use of the robot in ventral hernias exists with retrorectus and transversus abdominis release wherein the traditional laparoscopic repair is not achievable; therefore the clinical benefits of reduced wound morbidity, decreased post-operative pain, and reduced length-of-stay compared to the open technique are obtainable. Cost-effective practices in robotic hernia repairs have generally not been able to reach costs that compete with traditional laparoscopy or open repair techniques; however cost savings can occur if robotic repair techniques are chosen in situations that utilize cheaper non-coated mesh while reducing length of stay. Although touted and anecdotally reported as having an ergonomic benefit compared to traditional laparoscopy, more studies are required to examine the true ergonomic benefits in utilizing the da Vinci robotic surgical system.