Ann Surg Treat Res.  2023 Mar;104(3):176-181. 10.4174/astr.2023.104.3.176.

One-year experience of robotic transabdominal preperitoneal approach in a single institute: 2 different surgeons with different levels of experience

• Yoo RN
• Mun JY
• Cho HM
• Kye BH

• KMID: 2539697
• DOI: http://doi.org/10.4174/astr.2023.104.3.176

Abstract

Purpose
The robotic platform, an extension of minimally invasive procedures, is distributed nationwide and readily available. However, its application in inguinal hernia repair seems rare in Korea. This report aims to share our initial experience with robotic inguinal hernia repair.
Methods
The patients who underwent robotic inguinal hernia repair by 2 different surgeons with different experiences at a single center were retrospectively analyzed. The surgical procedures were performed on all patients using the Da Vinci Xi robotic platform (Intuitive Surgical Inc). Patient demographics, operation variables, and postoperative outcomes were analyzed.
Results
A total of 35 patients underwent robotic inguinal hernia repairs consecutively. The mean age was 55.03 ± 18.20 years. The majority of patients were male. The overall mean operation time was 103.98 ± 47.92 minutes for unilateral hernia surgery and 139.28 ± 46.07 minutes for bilateral surgery. None of the patients experienced intraoperative complications. However, postoperative complications were noticed in 8 patients: 3 with seroma formation, 1 with hematoma, 1 with superficial surgical site infection, and 3 with persistent pain at the operation site.
Conclusion
This report demonstrates an early experience of hernia surgery using the robotic platform. The robotic approach for transabdominal preperitoneal hernia repair was completed without any significant intraoperative or postoperative complications. It may be a viable option as a minimally invasive technique. Cost-effectiveness, optimal procedural steps, and indications for the robotic approach remain to be further investigated.

Keyword

Groin; Herniorrhaphy; Inguinal hernia; Minimally invasive surgical procedures; Robotic surgical procedures

Figure

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  Fig. 1 Schematic view of trocar sites.

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  Fig. 2 (A) Surgeon A’s trocar site. (B) Surgeon B’s trocar site.

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  Fig. 3 Creating the peritoneal flap.

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  Fig. 4 The myopectineal orifice with the adjacent anatomic landmarks.

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  Fig. 5 The mesh placement.

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  Fig. 6 The closed peritoneal flap.

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