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04.07.2018 | How-I-Do-It | Ausgabe 5/2018

Hernia 5/2018

Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair

Zeitschrift:
Hernia > Ausgabe 5/2018
Autoren:
I. Belyansky, H. Reza Zahiri, Z. Sanford, A. S. Weltz, A. Park
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10029-018-1795-z) contains supplementary material, which is available to authorized users.

Abstract

Background

The enhanced-view totally extraperitoneal (eTEP) hernia repair technique was first described for laparoscopic inguinal hernia repair and later applied to laparoscopic ventral and incisional hernia repair. We present our center’s early operative outcomes utilizing principles of this technique during robotic ventral and incisional hernia repair for implementation of the robotic eTEP Rives–Stoppa (eRS) and eTEP transversus abdominis release (eTAR) techniques.

Methods

A review of a prospectively maintained database of hernia patients was conducted identifying 37 patients who underwent robotic eTEP for ventral, incisional, flank or parastomal hernia repair between March and October 2017. All patients underwent retrorectus dissection with selective utilization of transversus abdominis release (TAR) as indicated.

Results

37 patients including 13 male and 24 female with mean age, body mass index, and ASA score of 54, 35.5, and 2.4, respectively, underwent a mean operation room time of 198 min. Mean length of stay was 0.7 days. There were no intraoperative complications. Two patients developed subcutaneous seromas requiring interventional radiology drainage. One patient was readmitted at 30 days for PO intolerance that was managed expectantly. Mean postoperative follow-up visit occurred at 36 days with no sign of early hernia recurrences.

Conclusion

The enhanced-view totally extraperitoneal approach is both safe and feasible in robotic-assisted repair of ventral and incisional hernias. Although long-term outcomes and patient selection criteria require further study, we believe this technique will become an important tool in the armamentarium of minimally invasive hernia surgeons.

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Zusatzmaterial
Supplementary material 1 A B C D: Introduction of the 5-mm laparoscope into the retrorectus space (TIF 1753 KB)
10029_2018_1795_MOESM1_ESM.tif
Supplementary material 2 A B C D: Sequence of port placement in lower midline defect repair (TIF 1592 KB)
10029_2018_1795_MOESM2_ESM.tif
Supplementary material 3 Robotic division of the posterior rectus sheaths (TIF 27616 KB)
10029_2018_1795_MOESM3_ESM.tif
Literatur
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