Novel robot-assisted laparoscopic total extra-peritoneal repair with primary fascial closure plus pre-peritonea mesh for large groin defects

Chih-Chin Yu; Chi-Wen Lo; Yung-Tai Chen; Chia-Da Lin; Shih-Chieh J Chueh; Yao Chou Tsai

doi:10.1002/rcs.2052

Novel robot-assisted laparoscopic total extra-peritoneal repair with primary fascial closure plus pre-peritonea mesh for large groin defects

Int J Med Robot. 2020 Feb;16(1):e2052. doi: 10.1002/rcs.2052. Epub 2019 Dec 3.

Authors

Chih-Chin Yu^{1

2}, Chi-Wen Lo^{1

2}, Yung-Tai Chen^{3

4}, Chia-Da Lin^{1

2}, Shih-Chieh J Chueh⁵, Yao Chou Tsai^{1

2

6

7}

Affiliations

¹ Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan.
² Medical College, Tzu Chi University, Hualien, Taiwan.
³ Department of Urology, Postal Hospital, Taipei, Taiwan.
⁴ Department of Urology, Taiwan Adventist Hospital, Taipei, Taiwan.
⁵ Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
⁶ Department of Urology, School of Medicine, College of Medicine.
⁷ Department of Urology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.

PMID: 31677211
DOI: 10.1002/rcs.2052

Abstract

Background: Since the introduction of robot-assisted laparoscopic surgery, a variety of conventional laparoscopic procedures have been explored via this approach. In the robotic era, most of the reported robot-assisted laparoscopic hernia repairs were performed with the trans-abdominal pre-peritoneal approach. According to the evidence extrapolated from laparoscopic ventral hernia repair, simultaneous fascial defect closure and mesh repair can significantly decrease the risk of seroma formation and recurrence over those without fascial closure. Therefore, we describe our novel technique of robot-assisted total extra-peritoneal (TEP) repair with primary fascial closure and pre-peritoneal mesh and its preliminary clinical outcomes.

Methods: We retrospectively reviewed our prospectively collected hernia database from October 2017 to July 2019, which included 26 consecutive patients with primary or recurrent groin hernias. Patients' baseline characteristics and perioperative outcomes were compared and analyzed. Perioperative factors included operative time, visual analog scale (VAS) score (0-100), hospital stay, perioperative complications, time to return to normal activity, and the modified Medical Outcome Study (MOS; item 3-12/36 items) score.

Results: All procedures were completed successfully without conversion to open or conventional laparoscopic surgery. The patients' age ranged from 28 to 74 years (median 57.5). The mean operative time was 115 minutes (range 95-172 min). There were no major procedure-related complications. Only four cases experienced asymptomatic seromas, which were detected by ultrasonography; and all resolved spontaneously within 6 weeks after the operation. The VAS and modified MOSs revealed quick recovery after robot-assisted endoscopic TEP repair.

Conclusions: Robot-assisted endoscopic TEP repair combined with primary fascial closure and pre-peritoneal mesh is a safe and feasible technique for groin hernia repair.

Keywords: TEP; inguinal hernia; laparoscopy; robotics.

MeSH terms

Adult
Aged
Fascia
Groin / surgery*
Herniorrhaphy / methods*
Humans
Laparoscopy / methods*
Male
Middle Aged
Operative Time
Peritoneum / surgery*
Retrospective Studies
Robotic Surgical Procedures / methods*
Surgical Mesh*