Abstract
Background
The da Vinci robot laparoscopic incisional hernia repair with intracorporeal suturing may offer an alternative to transabdominal sutures and tackers.
Methods
From 2003 to 2005, 11 patients (median age, 71 years; median body mass index [BMI], 28) with small and medium-sized incisional hernias (median fascial defect, 19.6 cm2) were treated with the da Vinci robot system using intracorporeal mesh fixation with interrupted sutures. This pilot study aimed to assess the feasibility and report the morbidity with special reference to postoperative pain and long-term recurrence.
Results
The median operative time was 180 min. There was no conversion to open or standard laparoscopy and no postoperative mortality. The overall morbidity rate was 27%. One patient underwent reoperation on postoperative day 3 for peritonitis secondary to small bowel injury. The median visual analog pain score on postoperative day 1 was 3. Seven patients (63%) needed parenteral paracetamol until postoperative day 2. The median hospital stay was 3 days. During a median follow-up period of 25 months, no patient experienced recurrent hernia. One patient had a trocar-site herniation at 6 months. No patient experienced chronic suture site pain or discomfort.
Conclusion
This is the first report of robot-assisted laparoscopic incisional hernia with exclusive intracorporeal suturing for mesh fixation in humans. The findings show that this technique is feasible and may not be associated with chronic postoperative pain. Further evaluation is needed to assess the benefit to the patient, but this investigation may be the basis for a future, prospective, randomized study.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ballantyne GH (2002) Robotic surgery, telerobotic surgery, telepresence, and telementoring: review of early clinical results. Surg Endosc 16: 1389–1402
Bower CE, Reade CC, Kirby LW, Roth JS (2004) Complications of laparoscopic incisional-ventral hernia repair: the experience of a single institution. Surg Endosc 18: 672–675
Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25: 1467–1477
Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, Pirozzi F, Caiazzo P (2005) Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc 19: 117–119
Earle D, Seymour N, Fellinger E, Perez A (2006) Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc 20: 71–75
Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138: 777–784
Heniford BT, Park A, Ramshaw BJ, Voeller G (2000) Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 190: 645–650
LeBlanc KA (2000) Current considerations in laparoscopic incisional and ventral herniorrhaphy. JSLS 4: 131–139
LeBlanc KA (2001) The critical technical aspects of laparoscopic repair of ventral and incisional hernias. Am Surg 67: 809–812
McKinlay RD, Park A (2004) Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg 8: 670–674
Park A, Birch DW, Lovrics P (1998) Laparoscopic and open incisional hernia repair: a comparison study. Surgery 124: 816–822
Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, Brunt LM (2005) Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery 138: 708–715
Robbins SB, Pofahl WE, Gonzalez RP (2001) Laparoscopic ventral hernia repair reduces wound complications. Am Surg 67: 896–900
Rudmik LR, Schieman C, Dixon E, Debru E (2006) Laparoscopic incisional hernia repair: a review of the literature. Hernia 10: 110–119
Schluender S, Conrad J, Divino CM, Gurland B (2003) Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing. Surg Endosc 17: 1391–1395
Talamini MA, Chapman S, Horgan S, Melvin WS (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17: 1521–1524
Tani KM, Neumayer L, Reda D, Kim L, Anthony T (2004) Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg 188: 22S–29S
Van’t RM, Vrijland WW, Lange JF, Hop WC, Jeekel J, Bonjer HJ (2002) Mesh repair of incisional hernia: comparison of laparoscopic and open repair. Eur J Surg 168: 684–689
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tayar, C., Karoui, M., Cherqui, D. et al. Robot-assisted laparoscopic mesh repair of incisional hernias with exclusive intracorporeal suturing: a pilot study. Surg Endosc 21, 1786–1789 (2007). https://doi.org/10.1007/s00464-007-9247-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9247-3