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Does robotic-assisted transabdominal preperitoneal (R-TAPP) hernia repair facilitate contralateral investigation and repair without compromising patient morbidity?

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Abstract

Inguinal hernia repair (IHR) is performed through either an open or minimally invasive approach (MIS). MIS allows for exploration and potential repair of an occult contralateral hernia. The aim of this study is to evaluate complications associated with intraoperative contralateral exploration and repair through robotic-assisted (da Vinci®) IHR. 652 robotic-assisted inguinal hernia procedures were uniformly and retrospectively collected from seven surgeons. Incidental contralateral findings were evaluated and populations with and without contralateral findings were compared in terms of demographics, operative characteristics and complications. This case series includes the earliest cases in each surgeon’s robotic-assisted IHR experience. Seventy-one percent (71%) of patients presented with a unilateral hernia. Intraoperative/incidental contralateral (“occult”) hernias were found in 12.3% of patients with a unilateral diagnosis. For patients with and without contralateral findings, there were no significant differences in demographics and baseline health characteristics. Perioperative morbidity was statistically similar between groups: intraoperative complications (0 vs 0.5%, p = 1.000), postoperative complications prior to discharge (0 vs 3.2%, p = 0.38) and from discharge through 30 days (5.3 vs 4.0%, p = 0.72), as well as readmissions and reoperations related to the repair within 30 days. Differences in setting of care, length of stay, rate of blood transfusions, concomitant procedures and conversions were nonsignificant. Mean operative time was longer in patients with a contralateral hernia by 19 min (p < 0.0001). Intraoperative contralateral exploration and subsequent repair during robotic-assisted IHR does not compromise perioperative patient morbidity. These study results support the increasing evidence for repair of contralateral, incidentally discovered inguinal hernias.

Clinicaltrials.Gov ID number: NCT02684448.

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References

  1. van den Heuvel B, Beudeker N, van den Broek J, Bogte A, Dwars BJ (2013) The incidence and natural course of occult inguinal hernias during TAPP repair: repair is beneficial. Surg Endosc 27:4142–4146

    Article  Google Scholar 

  2. Sayad P, Abdo Z, Cacchione R, Ferzli G (2000) Incidence of incipient contralateral hernia during laparoscopic hernia repair. Surg Endosc 14:543–545

    Article  CAS  Google Scholar 

  3. Novitsky Y, Czerniach DR, Kercher KW, Kaban GK, Gallagher KA, Kelly JJ, Heniford BT, Litwin DE (2007) Advantages of laparoscopic transabdominal preperitoneal herniorrhaphy in the evaluation and management of inguinal hernias. Am J Surg 193:466–470

    Article  Google Scholar 

  4. Bochkarev V, Ringley C, Vitamvas M, Oleynikov D (2007) Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects. Surg Endosc 21:734–736

    Article  CAS  Google Scholar 

  5. Griffin KJ, Harris S, Tang TY, Skelton N, Reed JB, Harris AM (2010) Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair. Hernia 14:345–349

    Article  CAS  Google Scholar 

  6. Lal P, Bansal B, Sharma R, Pradhan G (2016) Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion. Hernia 20:429–434

    Article  CAS  Google Scholar 

  7. Zheng R, Altieri MS, Yang J, Chen H, Pryor AD, m Bates A, Talamini MA, Telem DA (2017) Long-term incidence of contralateral primary hernia repair following unilateral inguinal hernia repair in a cohort of 32,834 patients. Surg Endosc 31:817–822

    Article  Google Scholar 

  8. Thumbe VK, Evans DS (2001) To repair or not to repair incidental defects found on laparoscopic repair of groin hernia: early results of a randomized control trial. Surg Endosc 15:47–49

    Article  CAS  Google Scholar 

  9. Waite KE, Herman MA, Doyle PJ (2016) Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 10:239–244

    Article  Google Scholar 

  10. Escobar Dominguez JE, Ramos MG, Seetharamaiah R, Donkor C, Rabaza J, Gonzalez A (2016) Feasibility of robotic inguinal hernia repair, a single-institution experience. Surg Endosc 30:4042–4048

    Article  Google Scholar 

  11. Engan C, Engan M, Bonilla V, Dyer DC, Randall BR (2015) Description of robotically assisted single-site transabdominal preperitoneal (RAAS-TAPP) inguinal hernia repair and presentation of clinical outcomes. Hernia 19:423–428

    Article  CAS  Google Scholar 

  12. Köckerling F, Schug-Pass C, Adolf D, Keller T, Kuthe A (2015) Bilateral and unilateral extraperitoneal inguinal hernia repair (TEP) have equivalent early outcomes: analysis of 9395 cases. World J Surg 39:1887–1894

    Article  Google Scholar 

  13. Jacob DA, Hackl JA, Bittner R, Kraft B, Köckerling F (2015) Perioperative outcome of unilateral versus bilateral inguinal hernia repairs in TAPP technique: analysis of 15,176 cases from the Herniamed Registry. Surg Endosc 29:3733–3740

    Article  CAS  Google Scholar 

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Acknowledgements

The authors acknowledge the following contributions: Usha Seshadri Kreaden for statistical analysis (Principal Biostatistician, Intuitive Surgical, Inc.), Sundeep Master for trial management (Manager, Clinical Affairs, Intuitive Surgical, Inc.) and Mimi Wainwright for editorial support (Wainwright Medical Communications).

Funding

This study was sponsored and funded by Intuitive Surgical Inc., Sunnyvale, CA, USA, in association with the identified study investigators under a cooperative clinical trial agreement. The authors had full control of the study execution, analysis and development of the manuscript.

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Correspondence to Eugene O. Dickens.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (retrospective) formal consent is not required, and a waiver of informed consent was obtained from each participating institution.

Conflict of interest

Drs. Dickens, Gamagami, Richardson, D’Amico, Gonzalez, Rabaza, and Kolachalam received clinical research grants from Intuitive Surgical. Drs. Dickens, Gamagami,  D’Amico, and Gonzalez 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 GibLib. Dr. D’Amico receives consulting fees from Ethicon. The authors have no other conflicts of interest or disclosures relevant to the study.

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Dickens, E.O., Kolachalam, R., Gonzalez, A. et al. Does robotic-assisted transabdominal preperitoneal (R-TAPP) hernia repair facilitate contralateral investigation and repair without compromising patient morbidity?. J Robotic Surg 12, 713–718 (2018). https://doi.org/10.1007/s11701-018-0815-4

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  • DOI: https://doi.org/10.1007/s11701-018-0815-4

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