Abstract
When approaching complex abdominal wall hernias at either index operation or a subsequent reoperation for recurrent incarcerated abdominal wall hernias, a majority of surgeons consider mesh placement a key step in the prevention of a future recurrence. While the laparoscopic and open approaches show no significant difference in hernia recurrence, the laparoscopic approach to complex abdominal wall hernias does reduce surgical-site infection, postoperative ileus, improves short-term quality-of-life scores, and reduces hospital length of stay (Davies et al. in Am Surg 78(8):888–892, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500604/, 2012, McGreevy et al. in Surg Endosc 17(11):1778–1780, https://www.ncbi.nlm.nih.gov/pubmed/12958679, 2003, Bittner et al. in Surg Endosc 33:3069–3139, https://doi.org/10.1007/s00464-019-06907-7, 2019). In this paper, we describe a robotic approach with a pulley technique to the fixation of polypropylene mesh in complex abdominal wall reconstruction. Our primary aim is to offer a new perspective to the re-creation of challenging abdominal walls and to encourage other surgeons to gain proficiency in the robotic approach. Additionally, the material cost to the technique is lower than that of self-expanding or deployable mesh reinforcements used in other laparoscopic approaches. Over time, as an institution breaks even on the cost of a robot with their return on investment, this technique offers potential cost-saving.
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Abbreviations
- T′:
-
Tension prime
- T o :
-
Tension knot
- F′:
-
Force prime
- cm:
-
Centimeter
- mmHg:
-
Millimeters of mercury
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The authors would like to acknowledge and thank Dr. Ryan Shadis and Dr. Robert Josloff for their expertise and assistance in creating this paper.
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Conceptualization and Methodology: SN; Writing: JB; Illustrations: JB; Editing: JB and SN. Supervision: SN.
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Butz, J.J., Newman, S.L. Robotic-assisted pulley technique for the ventral hernia. J Robotic Surg 15, 717–721 (2021). https://doi.org/10.1007/s11701-020-01161-9
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DOI: https://doi.org/10.1007/s11701-020-01161-9