Robotic and hybrid robotic transversus abdominis release may be performed with low length of stay and wound morbidity

https://doi.org/10.1016/j.amjsurg.2017.10.053Get rights and content

Highlights

  • A novel surgical technique is described: hybrid robotic transversus abdominis release (hrTAR).

  • hrTAR has similar length of stay (LOS) and wound morbidity to pure robotic TAR.

  • hrTAR has favorable LOS and wound morbidity to historical open TAR.

Abstract

The objective of our study was to compare length of stay and wound complications after hybrid robotic transversus abdominis release (hrTAR) vs. robotic transversus abdominis release (rTAR) Two cohorts of patients undergoing robotic (rTAR) and hybrid robotic (hrTAR) performed by two surgeons at a single institution were analyzed. Mean length of stay (LOS) and incidence of surgical site occurrences (SSO) were compared. 57 patients undergoing rTAR and 25 patients undergoing hrTAR were analyzed. The hrTAR group had larger mean hernia dimensions and a larger proportion of men but otherwise the patient cohorts were similar. LOS was not statistically different between rTAR and hrTAR (2.8 vs 3.7 days p = 0.06). We found no difference in incidence of surgical site occurrences between the two groups (7.0% vs 4.0% p = 0.52). Hybrid robotic assisted TAR allows for repair of complex ventral hernias with similar lengths of stay and wound morbidity to pure robotic repairs.

Section snippets

Background

Open repair with a wide sublay mesh coverage in the retro-rectus space, first popularized by Rives and Stoppa, is an effective method of repair with recurrence rates reported to be less than 5%1 and was adopted as the gold standard for ventral hernia repair by the American Hernia Society in 2004.2 Recent literature in the field of hernia repair has focused on restoration of abdominal wall dynamics by closure of the midline fascia. The Rives repair is limited by the semi-lunar lines and

Methods

Robotic assisted transversus abdominis release (rTAR) and hybrid partially open robotic assisted transversus abdominis release (hrTAR) performed by two surgeons from November 2015 to February 2017 were reviewed. Prospectively gathered data from the American Hernia Society Quality Collaborative (AHSQC) was retrospectively analyzed along with institutional electronic medical records. Data gathered included operation performed, patient characteristics such as age, body mass index (BMI),

Results

Analysis was performed on data gathered from the AHSQC and the institutional electronic medical record comparing 57 rTAR to 25 hrTAR patients. The two groups being analyzed were well matched and patient characteristics including Age, body mass index, percent of patients with hypertension, diabetes, current tobacco use, and percentage of patients with recurrent hernias. There was a higher proportion of women in the rTAR group. Wound classifications were not statistically different between rTAR

Discussion

We report the first description of the hybrid robotic transversus abdominis release approach which applies minimally invasive robotic assistance to a challenging subset of large ventral hernia patients, that would normally require an open component separation to restore the linea alba. Our study compared this group of patients (hrTAR) to a group of similar patients undergoing pure robot assisted TAR (rTAR). Our data demonstrate that hrTAR patients had similar length of stay (2.8 vs 3.7 days

Disclosures of conflicts

Randy J. Janczyk, MD: Has received honoraria from Intuitive Surgical.

Anthony A. Iacco, MD: Has received honoraria from Intuitive Surgical.

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