Skip to main content
SpringerLink
Log in

A comparison of robotic enhanced-view totally extraperitoneal approach versus trans-abdominal retro-muscular approach for midline ventral hernias

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Background

The evolution of midline ventral hernia repair has progressed from the open Rives-Stoppa technique to minimally invasive robotic approaches, notably the trans-abdominal retromuscular (TARM) and enhanced-view Totally Extraperitoneal (eTEP) methods. This study compares these two robotic techniques in repairing medium-sized midline ventral hernias.

Methods

A retrospective comparative study of electronic medical records from 2015 to 2021 was conducted on patients undergoing robotic TARM or eTEP at NYU Langone Hospital—Long Island. Data on demographics, comorbid conditions, surgical history, intraoperative details, hernia characteristics, and postoperative outcomes were analyzed.

Results

Both eTEP and TARM groups exhibited comparable outcomes regarding operative duration, hernia defect size, and overall complications. However, notable differences were observed in patients’ BMI, implanted mesh area, mesh composition, and fixation techniques across the groups. The TARM group required a longer hospital stay (median: 1 day) in contrast to the eTEP group (median: 0 days). Additionally, eTEP patients indicated reduced postoperative pain scores (median: 2) compared to TARM (median: 3), with both differences being statistically significant (p < 0.001).

Conclusion

The robotic eTEP approach is associated with lower post-operative pain scores, decreased hospital length of stay, and larger areas of mesh implantation as compared to the TARM approach. Other variables are largely comparable between the two techniques.

Level of evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Not applicable.

Abbreviations

BMI:

Body Mass Index

CAD:

Coronary Artery Disease

COPD:

Chronic Obstructive Pulmonary Disease

CRI:

Chronic Renal Insufficiency

CT:

Computed Tomography

DM:

Diabetes Mellitus

EBL:

Estimated Blood Loss

ED:

Emergency Department

eTEP:

Enhanced-view totally extraperitoneal

HTN:

Hypertension

LOS:

Length of Stay

NYU:

New York University

SD:

Standard Deviation

SSI:

Surgical Site Infection

SSO:

Surgical site occurrence

SSOPI:

Surgical site occurrence requiring procedural intervention

POST-OP:

Postoperative

TARM:

Trans-abdominal retromuscular

VAS:

Visual Analogue Scale

References

  1. Ventral Hernia Working Group, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558. https://doi.org/10.1016/j.surg.2010.01.008

    Article  Google Scholar 

  2. Masurkar AA (2020) Laparoscopic Trans-Abdominal Retromuscular (TARM) Repair for ventral hernia: a novel, low-cost technique for sublay and posterior component separation. World J Surg 44(4):1081–1085. https://doi.org/10.1007/s00268-019-05298-z

    Article  PubMed  Google Scholar 

  3. Santos DA, Limmer AR, Gibson HM, Ledet CR (2021) The current state of robotic retromuscular repairs-a qualitative review of the literature. Surg Endosc 35(1):456–466. https://doi.org/10.1007/s00464-020-07957-y

    Article  PubMed  Google Scholar 

  4. Belyansky I, Reza Zahiri H, Sanford Z, Weltz AS, Park A (2018) Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair. Hernia: J Hernias Abdom Wall Surg 22(5):837–847. https://doi.org/10.1007/s10029-018-1795-z

    Article  CAS  Google Scholar 

  5. Baig SJ, Priya P (2019) Extended totally extraperitoneal repair (eTEP) for ventral hernias: short-term results from a single centre. J Minim Access Surg 15(3):198–203. https://doi.org/10.4103/jmas.JMAS_29_18

    Article  PubMed  PubMed Central  Google Scholar 

  6. Carbonell A (2018) The 9th annual abdominal wall reconstruction summit, Montana, USA

  7. Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ (2018) A call for standardization of wound events reporting following ventral hernia repair. Hernia: J Hernias Abdom Wall Surg 22(5):729–736. https://doi.org/10.1007/s10029-018-1748-6

    Article  CAS  Google Scholar 

  8. Addo A, Lu R, Broda A, George P, Zahiri HR, Belyansky I (2021) Hybrid versus open retromuscular abdominal wall repair: early outcomes. Surg Endosc 35(10):5593–5598. https://doi.org/10.1007/s00464-020-08060-y

    Article  PubMed  Google Scholar 

  9. Zaman J, Teixeira L, Patel PB, Ridler G, Ata A, Singh TP (2023) From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes. Hernia: J Hernias Abdom Wall Surg 27(3):635–643. https://doi.org/10.1007/s10029-023-02767-2

  10. Rege SA, Churiwala JJ, A Kaderi AS, Kshirsagar KF, Dalvi AN (2021) Comparison of efficacy and safety of the enhanced-view totally extraperitoneal (eTEP) and transabdominal (TARM) minimal access techniques for retromuscular placement of prosthesis in the treatment of irreducible midline ventral hernia. J Minim Access Surg 17(4):519–524. https://doi.org/10.4103/jmas.JMAS_145_20

  11. Andreuccetti J, Sartori A, Lauro E, Crepaz L, Sanna S, Pignata G, Bracale U, Di Leo A (2021) Extended totally extraperitoneal Rives-Stoppa (eTEP-RS) technique for ventral hernia: initial experience of The Wall Hernia Group and a surgical technique update. Updat Surg 73(5):1955–1961. https://doi.org/10.1007/s13304-021-01067-7

    Article  Google Scholar 

  12. Kudsi OY, Chang K, Bou-Ayash N, Gokcal F (2020) Transabdominal (TA) versus totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair: a propensity score matching analysis. Surg Endosc 34(8):3550–3559. https://doi.org/10.1007/s00464-020-07574-9

    Article  PubMed  Google Scholar 

  13. Yang GP (2017) Laparoscopy in emergency hernia repair. Annals Laparosc Endosc Surg 2(6):23.

  14. Halpern DK, Liu H, Amodu LI, Weinman K, Akerman M, Petrone P (2023) Long term outcomes of robotic-assisted abdominal wall reconstruction: a single surgeon experience. Hernia: J Hernias Abdom Wall Surg 27(3):645–656. https://doi.org/10.1007/s10029-023-02774-3

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, NYU Langone Hospital—Long Island, 259 1St Street, Mineola, NY, 11501, USA

    Tulio Brasileiro Silva Pacheco, Hazim Hakmi, Robert Halpern, Amir Humza Sohail, Meredith Akerman, Kristen Weinman & David K. Halpern

Authors
  1. Tulio Brasileiro Silva Pacheco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hazim Hakmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amir Humza Sohail
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Meredith Akerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kristen Weinman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David K. Halpern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tulio Brasileiro Silva Pacheco.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable as this manuscript does not involve any active research on humans or animals.

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pacheco, T.B.S., Hakmi, H., Halpern, R. et al. A comparison of robotic enhanced-view totally extraperitoneal approach versus trans-abdominal retro-muscular approach for midline ventral hernias. Hernia (2024). https://doi.org/10.1007/s10029-024-03042-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10029-024-03042-8

Keywords

Search

Navigation