Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea

Inflammatory response and short-term outcomes after laparoscopic versus robotic transabdominal preperitoneal inguinal hernia repair: randomized clinical trial (ROLAIS)

BACKGROUND

The aim of this study was to compare robotic-assisted transabdominal preperitoneal (R-TAPP) and conventional laparoscopic transabdominal preperitoneal (L-TAPP) inguinal hernia repair with respect to surgical stress response and short-term outcomes.

METHODS

This single-centre, open-label, RCT enrolled patients undergoing elective inguinal hernia repair. Patients were randomized 1 : 1 to R-TAPP or L-TAPP using a computer-generated sequence with block sizes of six. All procedures were performed by the same experienced surgeons. The primary outcome was plasma C-reactive protein (CRP) levels. Secondary outcomes included interleukin 6 (IL-6) levels, operating time, complications, length of stay, and readmission rate.

RESULTS

A total of 150 patients (R-TAPP, 76; and L-TAPP, 74) were randomized, with 11 withdrawing before surgery, leaving 139 (R-TAPP, 74; and L-TAPP, 65) for intention-to-treat analysis. CRP levels were significantly lower after R-TAPP on postoperative days 1 and 3 (reductions of 23% and 32% respectively, P = 0.001). IL-6 levels were also lower after R-TAPP at 30 and 120 min after extubation (reductions of 26% and 22% respectively, P < 0.001). R-TAPP was associated with a shorter operating time (-13.4 min, P < 0.001), fewer complications (23.0% versus 41.5%, P = 0.029), including fewer haematomas (6.8% versus 18.5%, P = 0.043), and a higher same-day discharge rate (95.9% versus 81.5%, P = 0.012). No significant differences were observed regarding chronic pain and recurrence rates.

CONCLUSION

R-TAPP was associated with reduced surgical stress, complications, operating time, and hospitalization compared with L-TAPP. These findings support further multicentre trials to assess long-term outcomes and generalizability.

REGISTRATION NUMBER

NCT05839587 (http://www.clinicaltrials.gov).

A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century

Background: In the 21st century, the management of groin hernias (GHs) has evolved from watchful waiting (WW) to robotic hernia repair (RHR). The present study interrogates the status of robotics in the context of current repairs and provides one author's perspectives. Methods: A systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies comparing open (OHR) to robotic hernia repair (RHR); RHR to laparoscopic hernia repair (LHR); or OHR vs. LHR vs. RHR. The historical context was extracted from previous reviews. Results: Fifty-four studies were included in the analysis. Three techniques have withstood the test of time: OHR (tissue and mesh repairs), laparo-endoscopic (TEP and TAPP), and RHR. The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this technique. While the number of overall complications with RHR is similar to OHR, in a minority of cases, complications are more consequential with the robotic platform. Conclusions: RHR has emerged as an unequivocally powerful technique for the management of GHs. OHR remains the technique of choice for local/regional anesthesia, posterior recurrences, and in centers that lack other platforms. In low- and middle-income countries, OHR is the most utilized technique. Centers of excellence should offer all techniques of repair including WW.

Video Review Can Measure Surgical Robotic Skill Development in a Resident Robotic Hernia Curriculum: A Retrospective Cohort Study

Background

Hernia repairs are one of the most common general surgery procedures and an essential part of training for general surgery residents. The widespread incorporation of robotic hernia repairs warrants the development of a procedure-specific robotic curriculum to assist novice surgeons in improving technical skills.

Objective

To evaluate a robotic hernia simulation-based curriculum for general surgery residents using video review.

Methods

Retrospective cohort study of PGY-3 general surgery residents from the University of Chicago from 2019 to 2021. The residents completed inguinal hernia repair (IHR) and ventral hernia repair (VHR) drills as part of a robotic simulation curriculum. The drills were recorded and graded according to the modified objective structured assessment of technical skills (OSATS) and time to completion. The drills were completed by 3 attending surgeons to establish gold-standard benchmarks.

Results

In total, 20 residents started the curriculum, 19 completed all IHR drills and 17 completed all VHR drills. Attending surgeon total OSATS scores and time to completion were significantly better than the trainees on the first attempt (P < 0.05). When comparing 1st to 4th attempt, resident OSATS scores improved significantly for IHR (15.5 vs 23.3; P < 0.001) and VHR (16.8 vs 23.3; P < 0.001). Time also improved over 4 attempts (IHR: 28.5 vs 20.5 minutes; P < 0.001 and VHR: 29.6 vs 21.2 minutes; P < 0.001). Residents achieved attending-level OSATS scores by their fourth attempt for VHR, but not for IHR. Residents did not achieve attending-level times for either hernia drills.

Conclusions

The robotic hernia curriculum improved resident performance on hernia repair drills and was well-received by the residents.

Safety and feasibility of single-incision robotic totally extra-peritoneal repair for inguinal hernia using the da Vinci Xi platform: a single-center prospective pilot study

PURPOSE

This study aimed to report the safety and feasibility of single-incision robotic totally extra-peritoneal repair (TEP) with the da Vinci Xi platform.

METHODS

We prospectively included patients with unilateral inguinal hernia who underwent elective single-incision robotic TEP between August 10, 2021 and December 12, 2022. The primary outcome was the determination of postoperative complications, and secondary outcomes were quality of life and recurrence rate.

RESULTS

Twenty patients were included in this study. The median age of patients was 60 (interquartile range [IQR], 44.8-62) years, and most were male (90%). Eighteen patients had an indirect hernia. The median total operative time was 70 (IQR, 60.5-82.0) min, the median docking time was 5 (IQR, 3.3-6.0) min, and the median console time was 42 (IQR, 30.3-49.8) min. No postoperative complications occurred within six months postoperatively. We observed an upward trend in quality of life, which was low preoperatively, with improvement noted one month postoperatively. During the six-month follow-up period, there were no cases of recurrence.

CONCLUSION

For uncomplicated inguinal hernias, single-incision robotic TEP using the da Vinci Xi platform can be selectively and safely attempted.

Is There a Place for Robotic Inguinal Hernia Repair in the Realm of Laparoscopic and Open Inguinal Hernia Repair? A Narrative Review

INTRODUCTION

Robotic hernia repair is gaining popularity among general surgeons and has potential benefits; however, there are also several issues, of which the one related to increased cost compared to other procedures is the most important one. Integrating a robotic platform in the hernia territory is a difficult task, and this review attempts to analyze the various implications of using robotic assistance in inguinal hernias. From a hernia surgeon's perspective, each new addition to hernia procedures is important; therefore, we encompass the advantages and drawbacks of this technology. The final point is obviously improving hernia surgery and quality of life in our patients.

Abdominal Wall Hernias-State of the Art of Laparoscopic versus Robotic Surgery

Abdominal wall hernia repair, a common surgical procedure, includes various techniques to minimize postoperative complications and enhance outcomes. This review focuses on the comparison between laparoscopic and robotic approaches in treating inguinal and ventral hernias, presenting the ongoing situation of this topic. A systematic search identified relevant studies comparing laparoscopic and robotic approaches for inguinal and ventral hernias. Randomized control trials, retrospective, and prospective studies published after 1 January 2000, were included. Search terms such as hernia, inguinal, ventral, laparoscopy, robotic, and surgery were used. A total of 23 articles were included for analysis. Results indicated similar short-term outcomes for robotic and laparoscopic techniques in inguinal hernia repair, with robotic groups experiencing less postoperative pain. However, longer operative times and higher costs were associated with robotic repair. Robotic ventral hernia repair demonstrated potential benefits, including shorter hospital stay, lower recurrence and lower reoperation rates. While robotic surgery offers advantages such as shorter hospital stays, faster recovery, and less postoperative pain, challenges including costs and training requirements need consideration. The choice between laparoscopic and robotic approaches for abdominal wall hernias should be tailored based on individual surgeon expertise and resource availability, emphasizing a balanced evaluation of benefits and challenges.