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Long term outcomes of robotic-assisted abdominal wall reconstruction: a single surgeon experience

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Abstract

Introduction

Robotic abdominal wall reconstruction (RAWR) is one of the most significant advances in the management of complex abdominal wall hernias. The objective of this study was to evaluate long term outcomes in a cohort of patients that underwent complex RAWR in a single center.

Methods

This was a longitudinal retrospective review of a cohort of 56 patients who underwent complex RAWR at least 24 months prior by a single surgeon at a tertiary care institution. All patients underwent bilateral retro-rectus release (rRRR) with or without robotic transversus abdominis release (rTAR). Data collected include demographics, hernia details, operative and technical details. The prospective analysis included a post-procedure visit of at least 24 months from the index procedure with a physical examination and quality of life survey using the Carolinas Comfort Scale (CCS). Patients with reported symptoms concerning for hernia recurrence underwent radiographic imaging. Descriptive statistics (mean ± standard deviation or median) were calculated for continuous variables. Chi-square or Fisher’s exact test as deemed appropriate for categorical variables, and analysis of variance or the Kruskal–Wallis test for continuous data, were performed among the separate operative groups. A total score for the CCS was calculated and analyzed in accordance with the user guidelines.

Results

One-hundred and-forty patients met the inclusion criteria. Fifty-six patients consented to participate in the study. Mean age was 60.2 years. Mean BMI was 34.0. Ninety percent of patients had at least one comorbidity and 52% of patients were scored ASA 3 or higher. Fifty-nine percent were initial incisional hernias, 19.6% were recurrent incisional hernias and 8.9% were recurrent ventral hernias. The mean defect width was 9 cm for rTAR and 5 cm for rRRR. The mean implanted mesh size was 945.0 cm2 for rTAR and 362.5 cm2 for rRRR. The mean length of follow-up was 28.1 months. Fifty-seven percent of patients underwent post-op imaging at an average follow-up of 23.5 months. Recurrence rate was 3.6% for all groups. There were no recurrences in patients that underwent solely bilateral rRRR. Two patients (7.7%) that underwent rTAR procedures were found with recurrence. Average time to recurrence was 23 months. Quality of life survey demonstrated an overall CCS score of 6.63 ± 13.95 at 24 months with 12 (21.4%) patients reporting mesh sensation, 20 (35.7%) reporting pain, and 13 (23.2%) reporting movement limitation.

Conclusion

Our study contributes to the paucity of literature describing long term outcomes of RAWR. Robotic techniques offer durable repairs with acceptable quality of life metrics.

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Data availability

Data used for the conduct of this research is available upon request.

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Funding

Funding for this research was received from Intuitive Surgical Inc.

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Authors and Affiliations

  1. Department of Surgery, NYU Langone Hospital—Long Island, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA

    D. K. Halpern, H. Liu, L. I. Amodu, K. Weinman & P. Petrone

  2. Biostatistics Core, Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY, 11501, USA

    M. Akerman

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  1. D. K. Halpern
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  2. H. Liu
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  4. K. Weinman
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  6. P. Petrone
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Correspondence to D. K. Halpern.

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This study was approved by our Institutional Review Board (IRB). This is a retrospective study of medical records review that does not imply risk for patients, so informed consent was not required. The security and confidentiality of the data of the patients included in this study was guaranteed, during the process of collection, analysis and after the publication of the results.

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Halpern, D.K., Liu, H., Amodu, L.I. et al. Long term outcomes of robotic-assisted abdominal wall reconstruction: a single surgeon experience. Hernia 27, 645–656 (2023). https://doi.org/10.1007/s10029-023-02774-3

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