Skip to main content
SpringerLink
Log in

Robotic inguinal hernia repair: is the new Da Vinci single port platform providing any benefit?

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The utilization of the robot for inguinal hernia repairs has increased in the past years. The new Da Vinci Single Port (SP) system provides the benefits of single-incision procedures and might overcome the technical difficulties of previous single-incision techniques. The aim of this study was to evaluate the safety and feasibility of the SP transabdominal preperitoneal inguinal hernia repair (SP-TAPP) and compare its outcomes to the robotic multiport technique (MP-TAPP).

Methods

A prospective cohort of patients who underwent a robotic SP-TAPP and MP-TAPP between 2012 and 2022 was analyzed. Primary endpoints were same-day discharge, morbidity, and inguinal recurrence rates. Secondary endpoints included conversion, operative time, port-site incisional hernia, and chronic pain.

Results

MP-TAPP and SP-TAPP were performed in 378 (81.3%) and 87 (18.7%) patients, respectively. Demographics were similar between groups. There were no conversions or intraoperative complications. Mean operative (MP-TAPP: 93.2 vs. SP-TAPP: 78.1 min, p = 0.003) and recovery time (MP-TAPP: 160.8 vs SP-TAPP: 112.6 min, p < 0.001) were significantly shorter in the SP group. Same-day discharge rate was higher (MP-TAPP: 86.5% vs. SP-TAPP: 97.7%, p = 0.001) after SP-TAPP; 30-day morbidity, readmissions, and chronic pain rates were similar between groups. After a mean follow-up of 30.6 months for MP-TAPP and 13.3 months for SP-TAPP, inguinal hernia recurrence and port-site incisional rates were similar between groups.

Conclusion

Robotic SP-TAPP is safe and feasible. When compared to MP-TAPP, it showed similar postoperative morbidity, higher same-day discharge rates, and a quicker postoperative recovery. Further studies are needed to confirm the benefits of the SP platform.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  2. Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European Hernia society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13(4):343–403. https://doi.org/10.1007/s10029-009-0529-7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199. https://doi.org/10.1007/s00464-004-9126-0

    Article  CAS  PubMed  Google Scholar 

  4. Cardinali L, Mazzetti CH, Cadenas Febres A, Repullo D, Bruyns J, Dapri G (2018) Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc 32(7):3262–3272. https://doi.org/10.1007/s00464-018-6045-z

    Article  PubMed  Google Scholar 

  5. Sajid MS, Khawaja AH, Sayegh M, Baig MK (2016) A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg 29:25–35. https://doi.org/10.1016/j.ijsu.2016.02.088

    Article  CAS  PubMed  Google Scholar 

  6. Chueh KS, Lee HY, Yeh HC et al (2020) Comparison between single-incision and multiple-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair. Minim Invasive Ther Allied Technol 29(5):293–298. https://doi.org/10.1080/13645706.2019.1637895

    Article  PubMed  Google Scholar 

  7. Yussra Y, Sutton PA, Kosai NR et al (2013) Single incision laparoscopic surgery (SILS) inguinal hernia repair—recent clinical experiences of this novel technique. Clin Ter 164(5):425–428. https://doi.org/10.7417/CT.2013.1608

    Article  CAS  PubMed  Google Scholar 

  8. Rajapandian S, Bhushan C, Sabnis SC et al (2018) Single incision multiport versus conventional laparoscopic inguinal hernia repair: a matched comparison. J Minim Access Surg 14(1):44–51. https://doi.org/10.4103/jmas.JMAS_30_17

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guerron AD, Lee HJ, Yoo J et al (2017) laparoscopic single-site inguinal hernia repair using a self-fixating mesh. JSLS. 21(1):e2016.00103. https://doi.org/10.4293/JSLS.2016.00103

    Article  PubMed  PubMed Central  Google Scholar 

  10. Aiolfi A, Cavalli M, Micheletto G, Bruni PG, Lombardo F, Perali C, Bonitta G, Bona D (2019) Robotic inguinal hernia repair: is technology taking over? systematic review and meta-analysis. Hernia 23(3):509–519. https://doi.org/10.1007/s10029-019-01965-1

    Article  CAS  PubMed  Google Scholar 

  11. Waite KE, Herman MA, Doyle PJ (2016) Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 10(3):239–244. https://doi.org/10.1007/s11701-016-0580-1

    Article  PubMed  Google Scholar 

  12. Prabhu AS, Carbonell A, Hope W, Warren J, Higgins R, Jacob B, Blatnik J, Haskins I, Alkhatib H, Tastaldi L, Fafaj A, Tu C, Rosen MJ (2020) Robotic inguinal vs transabdominal laparoscopic inguinal hernia repair: the RIVAL randomized clinical trial. JAMA Surg 155(5):380–387. https://doi.org/10.1001/jamasurg.2020.0034.PMID:32186683;PMCID:PMC7081145

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bakker WJ, Roos MM, Kerkman T, Burgmans JPJ (2019) Experience with the PINQ-PHONE telephone questionnaire for detection of recurrences after endoscopic inguinal hernia repair. Hernia 23(4):685–691. https://doi.org/10.1007/s10029-019-01909-9

    Article  CAS  PubMed  Google Scholar 

  14. Ger R, Monroe K, Duvivier R, Mishrick A (1990) Management of indirect inguinal hernias by laparoscopic closure of the neck of the sac. Am J Surg 159(4):370–373. https://doi.org/10.1016/s0002-9610(05)81273-5

    Article  CAS  PubMed  Google Scholar 

  15. Abdelmoaty WF, Dunst CM, Neighorn C, Swanstrom LL, Hammill CW (2019) Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis. Surg Endosc 33(10):3436–3443. https://doi.org/10.1007/s00464-018-06606-9

    Article  PubMed  Google Scholar 

  16. Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23(4):920–921. https://doi.org/10.1007/s00464-008-0318-x

    Article  PubMed  Google Scholar 

  17. Ece I, Yilmaz H, Yormaz S, Sahin M (2017) Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair. J Minim Access Surg 13(1):37–41. https://doi.org/10.4103/0972-9941.181394

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim JH, Lee YS, Kim JJ et al (2013) Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 37:746–751. https://doi.org/10.1007/s00268-013-1925-9

    Article  PubMed  Google Scholar 

  19. Cugura JF, Kirac I, Kulis T, Sremac M, Ledinsky M, Beslin MB (2012) Comparison of single incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26(1):63–66. https://doi.org/10.1089/end.2011.0352

    Article  PubMed  Google Scholar 

  20. Buckley FP, Vassaur H, Monsivais S et al (2014) Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution. Surg Endosc 28:30–35. https://doi.org/10.1007/s00464-013-3145-7

    Article  PubMed  Google Scholar 

  21. Sato H, Shimada M, Kurita N, Iwata T, Nishioka M, Morimoto S, Yoshikawa K, Miyatani T, Goto M, Kashihara H, Takasu C (2012) The safety and usefulness of the single incision, transabdominal pre-peritoneal (TAPP) laparoscopic technique for inguinal hernia. J Med Invest 59(3–4):235–240. https://doi.org/10.2152/jmi.59.235

    Article  PubMed  Google Scholar 

  22. Perivoliotis K, Tzovaras G, Sarakatsianou C, Baloyiannis I (2019) Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis. Hernia 23(2):217–233. https://doi.org/10.1007/s10029-018-01876-7

    Article  CAS  PubMed  Google Scholar 

  23. Dobbs RW, Halgrimson WR, Talamini S, Vigneswaran HT, Wilson JO, Crivellaro S (2020) Single-port robotic surgery: the next generation of minimally invasive urology. World J Urol 38(4):897–905. https://doi.org/10.1007/s00345-019-02898-1

    Article  PubMed  Google Scholar 

  24. Park YM, Kim DH, Kang MS et al (2019) The first human trial of transoral robotic surgery using a single-port robotic system in the treatment of Laryngo-Pharyngeal cancer. Ann Surg Oncol 26(13):4472–4480. https://doi.org/10.1245/s10434-019-07802-0

    Article  PubMed  Google Scholar 

  25. Marks JH, Salem JF, Anderson BK, Josse JM, Schoonyoung HP (2020) Single-port robotic left colectomy: first clinical experience using the SP robot (Rsils). Tech Coloproctol 24(1):57–63. https://doi.org/10.1007/s10151-019-02129-0

    Article  CAS  PubMed  Google Scholar 

  26. Dreifuss NH, Schlottmann F, Cubisino A, Bianco FM (2021) Novel surgical approach for gastric gastrointestinal stromal tumor (GIST): robotic single port partial gastrectomy. Surg Oncol. https://doi.org/10.1016/j.suronc.2021.101704

    Article  PubMed  Google Scholar 

  27. Cruz CJ, Yang HY, Kang I, Kang CM, Lee WJ (2019) Technical feasibility of da Vinci SP single-port robotic cholecystectomy: a case report. Ann Surg Treat Res 97(4):217–221. https://doi.org/10.4174/astr.2019.97.4.217

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liu R, Zhao GD, Zhang XP et al (2022) The first case report of single-port robot-assisted pancreatectomy using the da Vinci SP system. Intelligent Surgery 1:32–35. https://doi.org/10.1016/j.isurg.2022.01.002

    Article  Google Scholar 

  29. Lee YS, Kim JH, Hong TH et al (2011) Transumbilical single-port laparoscopic transabdominal preperitoneal repair of inguinal hernia: initial experience of single institute. Surg Laparosc Endosc Percutan Tech 21(3):199–202. https://doi.org/10.1097/SLE.0b013e31821e5fac

    Article  PubMed  Google Scholar 

  30. Gong K, Zhang N, Lu Y, Zhu B, Zhang Z, Du D, Zhao X, Jiang H (2011) Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 25(1):234–239. https://doi.org/10.1007/s00464-010-1165-0

    Article  PubMed  Google Scholar 

  31. Krishna A, Misra MC, Bansal VK et al (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649

    Article  PubMed  Google Scholar 

  32. Antoniou SA, Morales-Conde S, Antoniou GA et al (2016) Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20(1):1–10. https://doi.org/10.1007/s10029-015-1371-8

    Article  CAS  PubMed  Google Scholar 

  33. Weiss HG, Brunner W, Biebl MO et al (2014) Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg 259(1):89–95. https://doi.org/10.1097/SLA.0b013e31827b7818

    Article  PubMed  Google Scholar 

  34. Harriott CB, Dreifuss NH, Schlottmann F, Sadava EE (2021) Incidence and risk factors for umbilical trocar site hernia after laparoscopic TAPP repair a single high-volume center experience. Surg Endosc 35(9):5167–5172. https://doi.org/10.1007/s00464-020-08007-3

    Article  PubMed  Google Scholar 

  35. Helgstrand F, Rosenberg J, Bisgaard T (2011) Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 15(2):113–121. https://doi.org/10.1007/s10029-010-0757-x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 820 S Wood Street, Rm 611 Clinical Sciences North, Chicago, IL, 60612, USA

    Nicolas H. Dreifuss, Betty Chang, Francisco Schlottmann, Antonio Cubisino, Alberto Mangano, Mario A. Masrur & Francesco M. Bianco

Authors
  1. Nicolas H. Dreifuss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Betty Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisco Schlottmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Cubisino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Mangano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario A. Masrur
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco M. Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicolas H. Dreifuss.

Ethics declarations

Disclosures

Nicolas H. Dreifuss, Betty Chang, Francisco Schlottmann, Antonio Cubisino, Alberto Mangano, and Mario A. Masrur have no conflicts of interest or financial ties to disclose. Francesco M. Bianco has an educational agreement with Intuitive Surgical and is consultant for Medtronic and Senhance. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dreifuss, N.H., Chang, B., Schlottmann, F. et al. Robotic inguinal hernia repair: is the new Da Vinci single port platform providing any benefit?. Surg Endosc 37, 2003–2013 (2023). https://doi.org/10.1007/s00464-022-09737-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09737-2

Keywords

Search

Navigation