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Surgical Endoscopy

, Volume 32, Issue 4, pp 2131–2136 | Cite as

Inguinal hernia repair: is there a benefit to using the robot?

  • Eric J. CharlesEmail author
  • J. Hunter Mehaffey
  • Carlos A. Tache-Leon
  • Peter T. Hallowell
  • Robert G. Sawyer
  • Zequan Yang
Article

Abstract

Background

The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair.

Methods

All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann–Whitney U.

Results

A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39–62], Lap: 57 [45–67], and Open: 56 [48–67] years, p = 0.03). Operative duration was also different (Robot: 105 [76–146] vs. Lap: 81 [61–103] vs. Open: 71 [56–88] min, p < 0.001). There were no operative mortalities and all patients except one were discharged home the same day. Postoperative occurrences (adverse events, readmissions, and death) were similar between groups (Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942–8375] vs. Lap: $4527 [$2310–6003] vs. Open: $4264 [$3277–5143], p < 0.001).

Conclusions

Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.

Keywords

Robotics Inguinal hernia repair Laparoscopic inguinal hernia repair Open inguinal hernia repair 

Notes

Acknowledgements

The authors acknowledge Kathleen B. Meneses for her assistance maintaining the robotic surgery database.

Funding

The National Heart, Lung, and Blood Institute under award numbers T32 HL007849 (JHM) and UM1 HL088925 (EJC) supported research reported in this publication.

Compliance with ethical standards

Disclosures

Dr. Hallowell reports an educational grant and travel expenses for an educational course from Intuitive Surgical, Inc. Dr. Sawyer reports consulting fees from 3M, Merck & Co., Inc., Pfizer Inc., and GlaxoSmithKline. Drs. Charles, Mehaffey, Tache-Leon, and Yang have no conflicts of interest or financial ties to disclose. The National Heart, Lung, and Blood Institute under award numbers T32 HL007849 (JHM) and UM1 HL088925 (EJC) supported research reported in this publication.

References

  1. 1.
    Heikkinen T, Bringman S, Ohtonen P, Kunelius P, Haukipuro K, Hulkko A (2004) Five-year outcome of laparoscopic and Lichtenstein hernioplasties. Surg Endosc 18:518–522CrossRefPubMedGoogle Scholar
  2. 2.
    Lau WY (2002) History of treatment of groin hernia. World J Surg 26:748–759CrossRefPubMedGoogle Scholar
  3. 3.
    Alkatout I, Mettler L, Maass N, Ackermann J (2016) Robotic surgery in gynecology. J Turk Ger Gynecol Assoc 17:224–232CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chitwood WR Jr (2016) Robotic mitral valve surgery: overview, methodology, results, and perspective. Ann Cardiothorac Surg 5:544–555CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lim SH, Lee HM, Son T, Hyung WJ, Kim HI (2016) Robotic surgery for gastric tumor: current status and new approaches. Transl Gastroenterol Hepatol 1:28CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mohd Azman ZA, Kim SH (2016) A review on robotic surgery in rectal cancer. Transl Gastroenterol Hepatol 1:5CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Stoikes N, Webb D, Voeller G (2016) Robotic hernia repair. Surg Technol Int 29:119–122Google Scholar
  8. 8.
    Escobar Dominguez JE, Gonzalez A, Donkor C (2015) Robotic inguinal hernia repair. J Surg Oncol 112:310–314CrossRefPubMedGoogle Scholar
  9. 9.
    Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332CrossRefPubMedGoogle Scholar
  10. 10.
    Collins JN, Britt RC, Britt LD (2011) Concomitant robotic repair of inguinal hernia with robotic prostatectomy. Am Surg 77:238–239PubMedGoogle Scholar
  11. 11.
    Kyle CC, Hong MK, Challacombe BJ, Costello AJ (2010) Outcomes after concurrent inguinal hernia repair and robotic-assisted radical prostatectomy. J Robot Surg 4:217–220CrossRefPubMedGoogle Scholar
  12. 12.
    Ito F, Jarrard D, Gould JC (2008) Transabdominal preperitoneal robotic inguinal hernia repair. J Laparoendosc Adv Surg Tech A 18:397–399CrossRefPubMedGoogle Scholar
  13. 13.
    Andolfi C, Umanskiy K (2017) Mastering robotic surgery: where does the learning curve lead us? J Laparoendosc Adv Surg Tech A 27(5):470–474CrossRefGoogle Scholar
  14. 14.
    Arcerito M, Changchien E, Bernal O, Konkoly-Thege A, Moon J (2016) Robotic inguinal hernia repair: technique and early experience. Am Surg 82:1014–1017PubMedGoogle Scholar
  15. 15.
    Cetrulo LN, Harmon J, Ortiz J, Canter D, Joshi AR (2015) Case report of a robotic-assisted laparoscopic repair of a giant incarcerated recurrent inguinal hernia containing bladder and ureters. Int J Med Robot 11:15–17CrossRefPubMedGoogle Scholar
  16. 16.
    Waite KE, Herman MA, Doyle PJ (2016) Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 10:239–244CrossRefPubMedGoogle Scholar
  17. 17.
    Campbell DA Jr, Henderson WG, Englesbe MJ, Hall BL, O’Reilly M, Bratzler D, Dellinger EP, Neumayer L, Bass BL, Hutter MM, Schwartz J, Ko C, Itani K, Steinberg SM, Siperstein A, Sawyer RG, Turner DJ, Khuri SF (2008) Surgical site infection prevention: the importance of operative duration and blood transfusion–results of the first American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative. J Am Coll Surg 207:810–820CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of VirginiaCharlottesvilleUSA

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