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Robotic repair of non-midline hernias

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Abstract

Non-midline abdominal wall hernias present unique anatomic challenges, making repair more complex. The constraints of the peritoneal cavity, pelvis, and costal margin limit the utility of intraperitoneal mesh repair, and extra-peritoneal repairs have traditionally been performed using open techniques, often resulting in higher wound morbidity. Advances in minimally invasive surgery make visualization and dissection of such complex cases feasible, with all the attendant benefits of a minimally invasive over an open approach. In this study, we examined the use of the robotic platform to repair non-midline hernias. Retrospective review of all non-midline abdominal wall hernias was performed robotically at Prisma Health, excluding parastomal hernias. Study conducted and outcomes reported according to STROBE statement. Repair was performed in the retro-rectus (n = 3) or retro-rectus + transversus abdominis release (TAR) (n = 39), pre-peritoneal (n = 22), and intraperitoneal (n = 1). Mean hernia width was 9.4 cm, permanent synthetic mesh used for all repairs. Mean LOS was 1.5 days. Surgical-site occurrence (SSO) occurred in 49.2%, 78% of which were simple seroma. Three patients (4.6%) developed surgical-site infection (SSI). Two recurrences were identified with a mean follow-up of 11 mos. The robotic platform facilitates complex dissection to allow minimally invasive, extra-peritoneal repair of complex non-midline hernias. This approach overcomes the anatomic constraints of intraperitoneal mesh repair and the wound morbidity of open repair.

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Data Availability

Data collected and analyzed for this study are available from the corresponding author upon reasonable request.

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Funding

No funding was received for any portion of this study.

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Authors and Affiliations

  1. University of South Carolina School of Medicine Greenville, Greenville, SC, USA

    Alyssa A. Guo

  2. Department of Medicine-Pediatrics, Prisma Health, Greenville, SC, USA

    Dillon Isaac

  3. Presbyterian College, Clinton, SC, USA

    Liliana Jaraczewski

  4. Prisma Health Upstate, Department of Surgery, University of South Carolina School of Medicine Greenville, 701 Grove Rd, Support Tower 3, Greenville, SC, 29607, USA

    William S. Cobb, Alfredo M. Carbonell & Jeremy A. Warren

Authors
  1. Alyssa A. Guo
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  2. Dillon Isaac
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  3. Liliana Jaraczewski
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  4. William S. Cobb
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  5. Alfredo M. Carbonell
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  6. Jeremy A. Warren
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Contributions

Study conception and design was done by JAW, WSC and AMC; acquisition of data by AAG, DI, and LJ; analysis and interpretation of data by AAG and JAW; drafting of manuscript by JAW and AAG; and critical revision by AAG, JAW, WSC, and AMC. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jeremy A. Warren.

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Conflict of interest

Drs. Warren and Carbonell have received honoraria for speaking and teaching from Intuitive Surgical. Drs. Carbonell and Cobb have received honoraria and consulting fees from W.L. Gore.

Ethical approval

The databased used for this study was approved by the Prisma Health Institutional Review Board.

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Guo, A.A., Isaac, D., Jaraczewski, L. et al. Robotic repair of non-midline hernias. J Robotic Surg 17, 1021–1027 (2023). https://doi.org/10.1007/s11701-022-01509-3

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  • DOI: https://doi.org/10.1007/s11701-022-01509-3

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