F Muysoms1, S Van Cleven2, P Pletinckx2, C Ballecer3, A Ramaswamy4. 1. Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9800, Ghent, Belgium. filip.muysoms@azmmsj.be. 2. Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9800, Ghent, Belgium. 3. Center for Minimally Invasive and Robotic Surgery, Phoenix, AZ, USA. 4. Department of Surgery, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, USA.
Abstract
PURPOSE: The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity in laparoscopic ventral hernia repair. We have adopted a robotic assisted laparoscopic technique using a lateral single-dock robotic access with retromuscular mesh placement after opening the ipsilateral posterior rectus fascia. In this study, we wanted to evaluate the changes in operative times during the initial experience with this novel technique. METHODS: The initial consecutive patients undergoing robotic assisted transabdominal retromuscular umbilical prosthetic repair (r-TARUP) using a 15 × 15 cm self-fixating mesh were prospectively entered in the study and the operative times during the separate steps of the surgical procedure were recorded. Complications were reported up to 4 week post operatively and quality of life was assessed using the EuraHS-QoL score. RESULTS: Over a 5 month inclusion period, 41 patients with either a primary (n = 34) or a trocar site hernia (n = 7) at the umbilicus were identified. All hernias had a mean diameter of less than 4 cm. The total OR time decreased significantly during the learning curve (tertile 1: 126 min versus tertile 3: 102 min; p = 0.002) due to a decrease in the skin-to-skin operating time (tertile 1: 81 min versus tertile 3:61 min; p = 0.002). The decrease in the retromuscular dissection time was the most significant of all the steps that comprised the console time (p = 0.004). The non-surgical time did not decrease (p = 0.15). The operation was performed on an outpatient basis in 68% of patients and with a one-night-stay in 29%. No complications related to the introduction of the robotic technique for this approach were observed and the early outcome is promising, with favorable quality-of-life evaluation at 4 weeks. CONCLUSIONS: The decrease in operative time during the adoption of r-TARUP was mainly related to the improved efficiency in the dissection phase of the procedure. The technique is reproducible and safe and the operative time compares favorably to published operative times for laparoscopic and open retromuscular umbilical hernia repair.
PURPOSE: The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity in laparoscopic ventral hernia repair. We have adopted a robotic assisted laparoscopic technique using a lateral single-dock robotic access with retromuscular mesh placement after opening the ipsilateral posterior rectus fascia. In this study, we wanted to evaluate the changes in operative times during the initial experience with this novel technique. METHODS: The initial consecutive patients undergoing robotic assisted transabdominal retromuscular umbilical prosthetic repair (r-TARUP) using a 15 × 15 cm self-fixating mesh were prospectively entered in the study and the operative times during the separate steps of the surgical procedure were recorded. Complications were reported up to 4 week post operatively and quality of life was assessed using the EuraHS-QoL score. RESULTS: Over a 5 month inclusion period, 41 patients with either a primary (n = 34) or a trocar site hernia (n = 7) at the umbilicus were identified. All hernias had a mean diameter of less than 4 cm. The total OR time decreased significantly during the learning curve (tertile 1: 126 min versus tertile 3: 102 min; p = 0.002) due to a decrease in the skin-to-skin operating time (tertile 1: 81 min versus tertile 3:61 min; p = 0.002). The decrease in the retromuscular dissection time was the most significant of all the steps that comprised the console time (p = 0.004). The non-surgical time did not decrease (p = 0.15). The operation was performed on an outpatient basis in 68% of patients and with a one-night-stay in 29%. No complications related to the introduction of the robotic technique for this approach were observed and the early outcome is promising, with favorable quality-of-life evaluation at 4 weeks. CONCLUSIONS: The decrease in operative time during the adoption of r-TARUP was mainly related to the improved efficiency in the dissection phase of the procedure. The technique is reproducible and safe and the operative time compares favorably to published operative times for laparoscopic and open retromuscular umbilical hernia repair.
Authors: Puraj P Patel; Michael W Love; Joseph A Ewing; Jeremy A Warren; William S Cobb; Alfredo M Carbonell Journal: Surg Endosc Date: 2016-06-23 Impact factor: 4.584
Authors: Alexander Daniel Schroeder; Eike Sebastian Debus; Michael Schroeder; Wolfgang Matthias Johann Reinpold Journal: Surg Endosc Date: 2012-09-06 Impact factor: 4.584
Authors: F Muysoms; G Campanelli; G G Champault; A C DeBeaux; U A Dietz; J Jeekel; U Klinge; F Köckerling; V Mandala; A Montgomery; S Morales Conde; F Puppe; R K J Simmermacher; M Śmietański; M Miserez Journal: Hernia Date: 2012-04-18 Impact factor: 4.739
Authors: F E Muysoms; M Miserez; F Berrevoet; G Campanelli; G G Champault; E Chelala; U A Dietz; H H Eker; I El Nakadi; P Hauters; M Hidalgo Pascual; A Hoeferlin; U Klinge; A Montgomery; R K J Simmermacher; M P Simons; M Smietański; C Sommeling; T Tollens; T Vierendeels; A Kingsnorth Journal: Hernia Date: 2009-06-03 Impact factor: 4.739
Authors: F Köckerling; R Lorenz; B Stechemesser; J Conze; A Kuthe; W Reinpold; H Niebuhr; B Lammers; K Zarras; R Fortelny; F Mayer; H Hoffmann; J F Kukleta; D Weyhe Journal: Hernia Date: 2021-07-28 Impact factor: 4.739