A L G Morrell1,2,3,4, A C Morrell5,6,7, L T Cavazzola8, G S S Pereira9, J M Mendes5,6,7, R Z Abdalla10, R B Garcia11, T N Costa10, A C Morrell-Junior5,7, F Malcher12. 1. Minimally Invasive and Robotic Digestive System Surgery, Instituto Morrell, São Paulo, SP, Brazil. andremorrell@gmail.com. 2. General and Digestive System Surgery, Brazilian Israeli Beneficent Society Albert Einstein, São Paulo, SP, Brazil. andremorrell@gmail.com. 3. Robotics General and Digestive System Surgery, Rede D'Or São Luiz, São Paulo, SP, Brazil. andremorrell@gmail.com. 4. , Rua Curitiba 133, apartamento 51, São Paulo, 04005-030, Brazil. andremorrell@gmail.com. 5. Minimally Invasive and Robotic Digestive System Surgery, Instituto Morrell, São Paulo, SP, Brazil. 6. General and Digestive System Surgery, Brazilian Israeli Beneficent Society Albert Einstein, São Paulo, SP, Brazil. 7. Robotics General and Digestive System Surgery, Rede D'Or São Luiz, São Paulo, SP, Brazil. 8. General Surgery Department, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil. 9. Department of General Surgery, General Hospital of Santa Mônica, Belo Horizonte, Divinópolis, MG, Brazil. 10. Department of Digestive Surgery, Clinicas Hospital of the Medical School of the University of Sao Paulo, São Paulo, SP, Brazil. 11. Advanced Hérnia Center, Sírio-Libanês Hospital, São Paulo, SP, Brazil. 12. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Abstract
PURPOSE: The enhanced view totally extraperitoneal (eTEP) concept first applied to inguinal hernias has become an important tool in the armamentarium of ventral hernia repair. The purpose of this report is to date the first brazilian robotic-assisted eTEP ventral hernia repair case series. METHODS: A review of a prospectively maintained database was conducted in patients who underwent robotic-assisted enhanced view totally extraperitoneal (eTEP) for ventral hernia repair between June 2018 and January 2020. Patients demographics, preoperative hernia characteristics, intraoperative variables and postoperative outcomes were evaluated. RESULTS: Our review identified 74 patients submitted to the procedure. Thirty-one patients (41.8%) presented primary ventral hernias (PVHs) and 43 patients (58.2%) presented incisional hernias (IHs). Female patients were predominant in both groups PVHs and IHs with 17 (22.9%) and 22 (29.7%) respectively, with a total of 39 patients (52.7%). Mean BMI was 29.1 kg/m2 (range 21.3-48.0 kg/m2) with higher mean BMI rates of 30.3 kg/m2 in the IHs group (range 22-48 years). A lateral dock setup was utilized in 55 cases (74.4%), having the inferior and superior dock setup in 18 (24.3%) and 1 (1.3%) cases respectively. Mean console time was 148.3 (range 75-277 min) and 192.6 min (range 66-301 min) in the PVHs and IHs groups respectively. There were no intraoperative complications or conversions. Average length of stay was 1.5 days. Four patients were readmitted within 30 days of surgery. There were no reoperation or cases of intraparietal herniation in this cohort. No hernia recurrence was verified during the mean 230.7 days of follow up in both groups. CONCLUSION: We present the first brazilian series to-date of the robotic assisted eTEP approach for ventral hernia repairs. Although long term outcomes require further analysis, its feasibility and reproducibility in experienced surgeons hands are evident, with safe and acceptable early postoperative outcomes.
PURPOSE: The enhanced view totally extraperitoneal (eTEP) concept first applied to inguinal hernias has become an important tool in the armamentarium of ventral hernia repair. The purpose of this report is to date the first brazilian robotic-assisted eTEP ventral hernia repair case series. METHODS: A review of a prospectively maintained database was conducted in patients who underwent robotic-assisted enhanced view totally extraperitoneal (eTEP) for ventral hernia repair between June 2018 and January 2020. Patients demographics, preoperative hernia characteristics, intraoperative variables and postoperative outcomes were evaluated. RESULTS: Our review identified 74 patients submitted to the procedure. Thirty-one patients (41.8%) presented primary ventral hernias (PVHs) and 43 patients (58.2%) presented incisional hernias (IHs). Female patients were predominant in both groups PVHs and IHs with 17 (22.9%) and 22 (29.7%) respectively, with a total of 39 patients (52.7%). Mean BMI was 29.1 kg/m2 (range 21.3-48.0 kg/m2) with higher mean BMI rates of 30.3 kg/m2 in the IHs group (range 22-48 years). A lateral dock setup was utilized in 55 cases (74.4%), having the inferior and superior dock setup in 18 (24.3%) and 1 (1.3%) cases respectively. Mean console time was 148.3 (range 75-277 min) and 192.6 min (range 66-301 min) in the PVHs and IHs groups respectively. There were no intraoperative complications or conversions. Average length of stay was 1.5 days. Four patients were readmitted within 30 days of surgery. There were no reoperation or cases of intraparietal herniation in this cohort. No hernia recurrence was verified during the mean 230.7 days of follow up in both groups. CONCLUSION: We present the first brazilian series to-date of the robotic assisted eTEP approach for ventral hernia repairs. Although long term outcomes require further analysis, its feasibility and reproducibility in experienced surgeons hands are evident, with safe and acceptable early postoperative outcomes.