Abstract
Background
The utilization of robotic platforms for general surgery procedures such as hernia repair is growing rapidly in the United States. A limited amount of data are available evaluating operative outcomes in comparison to standard laparoscopic surgery. We completed a retrospective review comparing robotic and laparoscopic ventral hernia repair to provide safety and outcomes data to help design a future prospective trial design.
Methods
A retrospective review of 215 patients undergoing ventral hernia repair (142 robotic and 73 laparoscopic) was completed at two large academic centers. Primary outcome measure evaluated was recurrence. Secondary outcomes included incidence of primary fascial closure, and surgical site occurrences.
Results
Propensity for treatment match comparison demonstrated that robotic repair was associated with a decreased incidence of recurrence (2.1 versus 4.2%, p < 0.001) and surgical site occurrence (4.2 versus 18.8%, p < 0.001). This may be because robotic repair was associated with increased incidence of primary fascial closure (77.1 versus 66.7%, p < 0.01). Analysis of baseline patient populations showed that robotic repairs were completed on patients with lower body mass index (28.1 ± 3.6 versus 34.2 ± 6.4, p < 0.001) and fewer comorbidities.
Conclusions
Our retrospective data show that robotic repair was associated with decreased recurrence and surgical site occurrence. However, the differences noted in the patient populations limit the interpretability of these results. As adoption of robotic ventral hernia repair increases, prospective trials need to be designed in order to investigate the efficacy, safety, and cost effectiveness of this evolving technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bower C, Roth JS (2013) Economics of abdominal wall reconstruction. Surgical Clin North Am 93:1241–1253
LeBlanc K, Booth WV (1993) Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 3(1):39–41
Stefanidis D, Hope WW et al (2011) Robotic suturing on the FLS model possesses construct validity, is less physically demanding, and is favored by more surgeons compared with laparoscopy. Surg Endosc 25(7):2141–2146
Gonzalez AM, Romero RJ et al (2015) Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of robotic technology. Int J Med Robot 11(2):120–125. https://doi.org/10.1002/rcs.1605
Allison N, Tieu K et al (2012) Technical feasibility of robot-assisted ventral hernia repair. World J Surg 36(2):447–452. https://doi.org/10.1007/s00268-011-1389-8
Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L (2017) Outcomes of robotic assisted versus laparoscopic repair of small size ventral hernias. Surg Endosc 31(3):1275–1279. https://doi.org/10.1007/s00464-016-5106-4
Prabhu AS, Dickens EO et al (2017) Laparoscopic vs robotic intraperitoneal mesh repair for incisional hernia: an Americas hernia society quality collaborative analysis. J Am Coll Surg 225(2):285–293
Nguyen DH, Nguyen MT et al (2014) Primary fascial closure with laparoscopic ventral hernia repair: systemic review. World J Surg 38(12):3097–3104
Wennergren JE, Askenasy EP et al. (2016) Laparoscopic ventral hernia repair with primary fascial closure versus bridged repair: a risk-adjusted comparative study. Surg Endosc 30(8):3231–3238
Tandon A, Pathak S et al. (2016) Meta-analysis of closure of the fascial defect during laparoscopic incision and ventral hernia repair. Br J Surg 103(12):1598–1607
Colavia PD, Tsirline VB et al. (2012) Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair. Ann Surg 256(5):714–722 (discussion 722-723)
Eriksen JR, Pormooroozy P et al (2009) Pain, quality of life and recovery after laparoscopic ventral hernia repair. Hernia 13(1):13–21. https://doi.org/10.1007/s10029-008-0414-9
Waasenaar E, Schoenmaeckers E et al. (2010) Mesh fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24(6):1296–1302. https://doi.org/10.1007/s00464-009-0763-1
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Walker and Shah have sponsored research agreements with Neosurgical and Medigus Inc. to complete randomized controlled trials for medical devices. Dr. Tsuda receives an honoria to proctor for Intuitive Surgical and to speak for Acelity Inc. Dr. Wilson has sponsored research agreements with Neosurgical and Medigus Inc. to complete randomized controlled trials for medical devices. He receives an honoria to speak for Ethicon and Gore Inc. He receives an honoria to proctor and train for both Apollo Inc. and Intuitive Inc. Ms. May, Mo, and Rosales Santilan, Mr. Kim, and Drs. Cherla and Ryan have no conflicts of interest or financial interests to disclose.
Rights and permissions
About this article
Cite this article
Walker, P.A., May, A.C., Mo, J. et al. Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?. Surg Endosc 32, 1901–1905 (2018). https://doi.org/10.1007/s00464-017-5882-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-017-5882-5