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Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study

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Abstract

Background

Minimally invasive inguinal hernia repair (IHR) in general and particularly in obese patients has not been widely adopted, potentially due to the perceived technical challenges and the well-documented learning curve associated with laparoscopic repair. Outcomes in robotic-assisted IHR in obese (BMI ≥ 30 kg/m2) patients have not been described and warrant study.

Methods

Seven surgeons conducted a multicenter retrospective chart review of their early robotic-assisted IHR (RHR) cases and compared them with their open IHR (OHR) cases. Demographics, operative characteristics, and perioperative morbidity were compared for unadjusted and propensity-matched populations.

Results

651 robotic-assisted cases and 593 open cases were collected. The outcomes of 148 RHRs to 113 OHRs in obese patients were compared. For obese populations—whether unadjusted (robotic-assisted, n = 148; open, n = 113) or matched (1:1) (robotic-assisted, n = 95; open, n = 93)—the robotic-assisted and open cohorts were comparable in terms of demographics and baseline characteristics. Significantly higher percentages of OHR patients experienced postoperative complications post-discharge (unadjusted: 11.5% vs. 2.7%, p = 0.005; and matched: 10.8% vs. 3.2%, p = 0.047). More concomitant procedures and bilateral repairs were conducted in obese RHR patients than in obese OHR patients (unadjusted 29.7% vs. 16.8%, p = 0.019; and unadjusted 35.1% vs. 11.5%, p < 0.0001—respectively). Prior laparoscopic IHR experience did not affect 30-day outcomes.

Conclusions

Obese patients who undergo RHR have a lower rate of postoperative complications compared to obese patients who undergo OHR. Previous laparoscopic IHR experience, more bilateral repairs, and more concomitant procedures were not associated with increased complications in RHR patients. These outcomes may facilitate increased adoption of minimally invasive IHR approaches in the obese population.

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Acknowledgements

The authors thank Sundeep Master (Manager, Clinical Affairs; Intuitive Surgical) for organizing the multitude of components required for the preparation and completion of the study, Usha Seshadri Kreaden (Principal Biostatistician; Intuitive Surgical) for completing the statistical analysis of the collected data, and Wainwright Medical Communications for independent research and editorial guidance.

Funding

Study is sponsored by Intuitive Surgical, Inc. for data collection, statistical analysis, and independent editorial support. Authors retained full control of the review of the data analysis and the development and final approval of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Providence-Providence Park Hospital, 26850, Providence Pkwy, Suite 460, Novi, MI, 48374, USA

    Ramachandra Kolachalam

  2. Hillcrest Medical Center and Oklahoma Physician Group, Tulsa, OK, USA

    Eugene Dickens

  3. ValleyCare Health System of Ohio, Trumbull Memorial Hospital, Warren, OH, USA

    Lawrence D’Amico

  4. Rochester General Hospital, Rochester, NY, USA

    Christopher Richardson

  5. Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA

    Jorge Rabaza & Anthony Gonzalez

  6. Silver Cross Hospital, New Lenox, IL, USA

    Reza Gamagami

Authors
  1. Ramachandra Kolachalam
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  2. Eugene Dickens
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  3. Lawrence D’Amico
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  4. Christopher Richardson
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  5. Jorge Rabaza
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  6. Reza Gamagami
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  7. Anthony Gonzalez
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Corresponding author

Correspondence to Ramachandra Kolachalam.

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Disclosures

Drs. Kolachalam, Gamagami, Dickens, Gonzalez, D’Amico, Richardson, and Rabaza received clinical research grants for data collection from Intuitive Surgical. Drs. Dickens, Gamagami, Gonzalez, and D’Amico receive personal fees for consulting and education from Intuitive. Dr. Dickens receives personal fees for consulting and education from Covidien and is an advisor (with ownership) to GibLab. Dr. D’Amico receives consulting fees from Ethicon.

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Kolachalam, R., Dickens, E., D’Amico, L. et al. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc 32, 229–235 (2018). https://doi.org/10.1007/s00464-017-5665-z

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  • DOI: https://doi.org/10.1007/s00464-017-5665-z

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