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Hernia

pp 1–11 | Cite as

Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair

  • I. Belyansky
  • H. Reza Zahiri
  • Z. Sanford
  • A. S. Weltz
  • A. Park
How-I-Do-It

Abstract

Background

The enhanced-view totally extraperitoneal (eTEP) hernia repair technique was first described for laparoscopic inguinal hernia repair and later applied to laparoscopic ventral and incisional hernia repair. We present our center’s early operative outcomes utilizing principles of this technique during robotic ventral and incisional hernia repair for implementation of the robotic eTEP Rives–Stoppa (eRS) and eTEP transversus abdominis release (eTAR) techniques.

Methods

A review of a prospectively maintained database of hernia patients was conducted identifying 37 patients who underwent robotic eTEP for ventral, incisional, flank or parastomal hernia repair between March and October 2017. All patients underwent retrorectus dissection with selective utilization of transversus abdominis release (TAR) as indicated.

Results

37 patients including 13 male and 24 female with mean age, body mass index, and ASA score of 54, 35.5, and 2.4, respectively, underwent a mean operation room time of 198 min. Mean length of stay was 0.7 days. There were no intraoperative complications. Two patients developed subcutaneous seromas requiring interventional radiology drainage. One patient was readmitted at 30 days for PO intolerance that was managed expectantly. Mean postoperative follow-up visit occurred at 36 days with no sign of early hernia recurrences.

Conclusion

The enhanced-view totally extraperitoneal approach is both safe and feasible in robotic-assisted repair of ventral and incisional hernias. Although long-term outcomes and patient selection criteria require further study, we believe this technique will become an important tool in the armamentarium of minimally invasive hernia surgeons.

Keywords

Hernia Ventral hernia Incisional hernia Robotic hernia surgery Extended-view totally extraperitoneal eTEP eRS eTAR AWR Abdominal wall reconstruction 

Notes

Acknowledgements

Figures are reprinted from “Robotic Extended-View Totally Extraperitoneal Access Rives-Stoppa Repair”, by Belyansky I, Sanford Z, Weltz AS, Zahiri HR, 2018, Atlas of Robotic Surgery. Copyright (2018) by Ciné-Med, Inc.

Compliance with ethical standards

Conflict of interest

Dr. Igor Belyansky's disclosures are honoraria and consulting fees from Intuitive, Bard, Medtronic, and Allergan. Drs. H. Reza Zahiri, Zachary Sanford, Adam S. Weltz, and Adrian E. Park have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards.

Human and animal rights

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

Informed consent

All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.

Supplementary material

10029_2018_1795_MOESM1_ESM.tif (1.7 mb)
Supplementary material 1 A B C D: Introduction of the 5-mm laparoscope into the retrorectus space (TIF 1753 KB)
10029_2018_1795_MOESM2_ESM.tif (1.6 mb)
Supplementary material 2 A B C D: Sequence of port placement in lower midline defect repair (TIF 1592 KB)
10029_2018_1795_MOESM3_ESM.tif (27 mb)
Supplementary material 3 Robotic division of the posterior rectus sheaths (TIF 27616 KB)

References

  1. 1.
    Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS, Sibia US, Park A, Novitsky Y (2017) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32:1525–1532CrossRefPubMedGoogle Scholar
  2. 2.
    Martin-Del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2017) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32:840–845CrossRefPubMedGoogle Scholar
  3. 3.
    Berguer R, Smith W (2006) An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res 134:87–92CrossRefPubMedGoogle Scholar
  4. 4.
    van der Schatte Olivier RH, Van’t Hullenaar CD, Ruurda JP, Broeders IA (2009) Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery. Surg Endosc 23:1365–1371CrossRefPubMedGoogle Scholar
  5. 5.
    Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Lango T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R, European Association of Endoscopic S (2015) European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 29:253–288CrossRefPubMedGoogle Scholar
  6. 6.
    Plerhoples TA, Hernandez-Boussard T, Wren SM (2012) The aching surgeon: a survey of physical discomfort and symptoms following open, laparoscopic, and robotic surgery. J Robot Surg 6:65–72CrossRefPubMedGoogle Scholar
  7. 7.
    Petro CC, Como JJ, Yee S, Prabhu AS, Novitsky YW, Rosen MJ (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429CrossRefPubMedGoogle Scholar
  8. 8.
    Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232CrossRefPubMedGoogle Scholar
  9. 9.
    Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716CrossRefPubMedGoogle Scholar
  10. 10.
    Blatnik JA, Krpata DM, Novitsky YW (2016) Transversus abdominis release as an alternative component separation technique for ventral hernia repair. JAMA Surg 151:383–384CrossRefPubMedGoogle Scholar
  11. 11.
    Harris PATR, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMedGoogle Scholar
  12. 12.
    Daes J (2012) The enhanced view-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26:1187–1189CrossRefPubMedGoogle Scholar
  13. 13.
    Moore LJ, Wilson MR, Waine E, Masters RS, McGrath JS, Vine SJ (2015) Robotic technology results in faster and more robust surgical skill acquisition than traditional laparoscopy. J Robot Surg 9:67–73CrossRefPubMedGoogle Scholar
  14. 14.
    Park BS, Ryu DY, Son GM, Cho YH (2014) Factors influencing on difficulty with laparoscopic total extraperitoneal repair according to learning period. Ann Surg Treat Res 87:203–208CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Smith CD, Farrell TM, McNatt SS, Metreveli RE (2001) Assessing laparoscopic manipulative skills. Am J Surg 181:547–550CrossRefPubMedGoogle Scholar
  16. 16.
    Lee GI, Lee MR, Green I, Allaf M, Marohn MR (2017) Surgeons’ physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study. Surg Endosc 31:1697–1706CrossRefPubMedGoogle Scholar
  17. 17.
    Belyansky I, Weltz AS, Sibia US, Turcotte JJ, Taylor H, Zahiri HR, Turner TR, Park A (2017) The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it? Surg Endosc 32:1701–1707CrossRefPubMedGoogle Scholar
  18. 18.
    Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK (2017) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair. A comparative analysis from the Americas Hernia Society quality collaborative. Ann Surg 267:210–217CrossRefGoogle Scholar
  19. 19.
    Gibreel W, Sarr MG, Rosen M, Novitsky Y (2016) Technical considerations in performing posterior component separation with transverse abdominis muscle release. Hernia 20:449–459CrossRefPubMedGoogle Scholar
  20. 20.
    Krpata DM, Blatnik JA, Novitsky YW, Rosen MJ (2012) Posterior and open anterior components separations: a comparative analysis. Am J Surg 203:318–322 (discussion 322) CrossRefPubMedGoogle Scholar
  21. 21.
    Ballecer C, Prebil B (2015) Robotic Rives-Stoppa incisional hernia repair with bilateral posterior component separation. Abdom Wall Repair J 3:12–16Google Scholar
  22. 22.
    Hogg ME, Tam V, Zenati M, Novak S, Miller J, Zureikat AH, Zeh HJ III (2017) Mastery-based virtual reality robotic simulation curriculum: the first step toward operative robotic proficiency. J Surg Educ 74:477–485CrossRefPubMedGoogle Scholar
  23. 23.
    Bric J, Connolly M, Kastenmeier A, Goldblatt M, Gould JC (2014) Proficiency training on a virtual reality robotic surgical skills curriculum. Surg Endosc 28:3343–3348CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • I. Belyansky
    • 1
  • H. Reza Zahiri
    • 1
  • Z. Sanford
    • 1
  • A. S. Weltz
    • 1
  • A. Park
    • 1
    • 2
  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA

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