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Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes

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Abstract

Background

The open approach continues to be widely performed for ventral hernia repair, while the minimally invasive laparoscopic approach has grown adoption over the last decade. Recently, robotic operation was described as a new modality due to the ease for performing intracorporeal closure of the hernia defect. This study is one of the first multi-institutional case series evaluating robotic-assisted laparoscopic ventral hernia repairs, with the goal of describing robotic-assisted surgical techniques for ventral and incisional hernia repair and the outcomes in teaching and community hospital settings.

Methods

Medical records of consecutive patients (including surgeon’s learning curve cases) who underwent ventral or incisional hernia repair utilizing the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale CA) were retrospectively reviewed. Data collected included preoperative history and perioperative outcomes.

Results

Data for a total of 368 patients from four institutions involving five surgeons were analyzed. They were predominantly females (60.3 %), and the mean age was 51 years. The majority of the patients were obese or morbidly obese (47.8 and 20.9 %), and 83.2 % of the patients had a history of prior abdominal operation. Conversion rate was 0.8 %, and mean length of stay was 1 day. Total postoperative complications rate up to 30 days was 8.4 %, of which incidence of paralytic ileus was 2.4 %.

Conclusion

This large case series of 368 patients demonstrates reproducibility of safety and performance associated with robotic-assisted ventral hernia repairs performed by five surgeons at four institutions. In addition, the results of short term perioperative outcomes for surgeons during their early experience for robotic-assisted cases are in the range of what is reported in the existing published data on laparoscopic and open ventral hernia repairs. Further comparative evidence initiatives are being pursued to determine the benefits of robotic-assisted technique and technology for long-term and patient-reported outcomes.

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Acknowledgments

The authors acknowledge Monica Shah, MD, Intuitive Surgical for her support during study planning, execution, and the manuscript review.

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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Authors and Affiliations

  1. Department of General and Bariatric Surgery, Baptist Health South Florida, 7800 SW 87th Ave. Suite B210, Miami, FL, 33173, USA

    Anthony Gonzalez, Ernesto Escobar, Rey Romero & Jorge Rabaza

  2. Population Health and Outcomes Research, Center for Research and Grants, Baptist Health South Florida, Miami, FL, USA

    Gail Walker, Jacqueline Mejias & Michelle Gallas

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

    Eugene Dickens

  4. Mid-Florida Surgical Associates, Clermont, FL, USA

    Christopher J. Johnson

  5. Steward Good Samaritan Medical Center, Brockton, MA, USA

    Omar Yusef Kudsi

Authors
  1. Anthony Gonzalez
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  2. Ernesto Escobar
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  3. Rey Romero
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  9. Jorge Rabaza
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Corresponding author

Correspondence to Anthony Gonzalez.

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Disclosures

Rey Romero, MD, Ernesto Escobar, MD, Gail Walker, PhD, Michelle Gallas, PhD, and Jacqueline Mejias, CCRC received research support through the grant from Intuitive Surgical by their respective Institutions for this study. Anthony Gonzalez, MD is a consultant and has received research grants from Intuitive Surgical. He is a consultant with Ethicon. He is on the speaker bureau of Mallinkrodt Pharmaceuticals. He has also received research grants and participated in the scientific advisory board for Minimally Invasive Devices, Inc. Jorge Rabaza, MD is a proctor for Intuitive Surgical. Eugene Dickens, MD is a proctor and a consultant for Intuitive Surgical and a consultant for Medtronics. Omar Yusef Kudsi, MD, MBA, FACS is a Consultant for Intuitive Surgical and Medtronics. Christopher J. Johnson, DO, FACOS is a proctor and consultant for Intuitive Surgical.

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Gonzalez, A., Escobar, E., Romero, R. et al. Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc 31, 1342–1349 (2017). https://doi.org/10.1007/s00464-016-5118-0

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  • DOI: https://doi.org/10.1007/s00464-016-5118-0

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