scholarly journals P134 ROBOTICALLY ASSISTED EXTENDED VIEW TOTALLY EXTRAPERITONEAL VENTRAL HERNIA REPAIR (ETEP) - ESTABLISHMENT OF A NEW SURGICAL TECHNIQUE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Björn Mück ◽  
Frank Heinzelmann ◽  
Robert Vogel ◽  
Peter Büchler
Keyword(s):  
Minimally Invasive ◽  
Ventral Hernia ◽  
Intraoperative Complications ◽  
Lateral Approach ◽  
Transversus Abdominis ◽  
Open Approach ◽  
Mesh Placement ◽  
Surgical Method ◽  
Totally Extraperitoneal ◽  
Minimally Invasive Surgical

Abstract Aim Even today, operations which include retromuscular mesh placement are usually performed using an open approach. Thanks to advent of robotics, these technically demanding operations can be carried out using minimally invasive techniques. The objective of this investigation is to establish a novel minimally invasive surgical method as part of a feasibility study in a hospital providing specialised care. Material and Methods We carried out a retrospective analysis, out of all patients who were operated on a ventral hernia, using a robotically assisted totally extraperitoneal technique, during the period between September 2019 and May 2021. For evaluation we used data from our hospitals information system. All patients had given their consent, to participate in the Herniamed quality assurance study. Results From September 2019 to May 2021, 33 patients underwent robotic surgery on a ventral hernia, using a totally extraperitoneal approach. 23 patients had an incisional hernia (69.70%), 10 patients had a primary hernia (30.30%). We did perform a total of 3 unilateral and 2 bilateral Transversus Abdominis Releases (TAR). A lateral approach was chosen in 26 patients and a caudal “bottom-up” approach in 7 patients. There were no intraoperative complications. A conversion was not necessary. Postoperative complications did occur in 3 patients (2 Clavien Dindo 1, 1 Clavien Dindo 3a). Reoperation was not needed. Conclusions The eTEP technique is a promising surgical method, that can also be carried out in a hospital providing specialised care, with an acceptable risk of complications. This technique enables us, to combine the advantages of minimally invasive surgery with those of extraperitoneal mesh placement.

scholarly journals P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Hiroshi Hirukawa
Keyword(s):  
Ventral Hernia ◽  
Mesh Repair ◽  
Transversus Abdominis ◽  
Incisional Hernias ◽  
Totally Extraperitoneal ◽  
Onlay Mesh ◽  
The Mean ◽  
Totally Extraperitoneal Repair ◽  
Hernia Size ◽  
Ventral Hernias

Abstract Aim We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution. Material and Methods Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively. Results There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP. Conclusions The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (>8cm).

Readmissions After Lobectomy in an Era of Increasing Minimally Invasive Surgery: A Statewide Analysis

2019 ◽  
Vol 14 (5) ◽  
pp. 453-462
Author(s):  
Brandon S. Hendriksen ◽  
Michael F. Reed ◽  
Matthew D. Taylor ◽  
Christopher S. Hollenbeak
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Health Care Cost ◽  
Thoracoscopic Surgery ◽  
Patient Characteristics ◽  
Open Approach ◽  
Minimally Invasive Surgical ◽  
Chi Squared ◽  
The Impact ◽  
Video Assisted Thoracoscopic Surgery

Objective Utilization of minimally invasive surgical modalities for lobectomy is increasing. Lobectomy can be associated with notable rates of readmission. As use of these modalities increases, evaluation of the impact on readmission is warranted. Methods Data from the Pennsylvania Health Care Cost Containment Council were used to identify lobectomy operations performed in Pennsylvania from 2011 through 2014. Operations were stratified by approach: open, video-assisted thoracoscopic surgery (VATS) or robotic. Differences in patient characteristics were assessed with analysis of variance and chi-squared tests. Logistic regression modeled risk of 30-day readmission and linear regression modeled length of stay (LOS) after controlling for confounders. Results We evaluated 4,939 lobectomy operations (2,501 open, 1,944 VATS, 494 robotic) with 583 readmissions (11.8%). Robotic cases increased 333% over 4 years. VATS and open cases increased 38% and 22%, respectively. Surgical approach was not associated with hospital readmission (VATS odds ratio (OR) = 0.95; P = 0.632; and robotic OR = 1.02; P = 0.916). Longer LOS was associated with a greater likelihood of readmission (OR = 1.58; P = 0.002). LOS was 1 day less for VATS ( P < 0.001) and 1.5 days less for robotic lobectomy ( P < 0.001) when compared to an open approach. The most common reasons for readmission were respiratory complications and nonrespiratory infection. Conclusions Surgical approach does not directly affect readmission. However, minimally invasive lobectomy appears to be associated with shorter LOS and results in more patients discharged home. Decreased LOS and discharge home are associated with fewer readmissions.

scholarly journals Minimálisan invazív, endoszkóppal asszisztált, transcribriform reszekció a koponyaalap rosszindulatú daganatainak sebészetében

2019 ◽  
Vol 160 (40) ◽  
pp. 1584-1590
Author(s):  
Zalán Piski ◽  
András Büki ◽  
Imre Gerlinger ◽  
István Tóth ◽  
Nelli Nepp ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Intraoperative Complications ◽  
Anterior Skull Base ◽  
Open Approach ◽  
Malignant Tumours ◽  
Recurrent Tumour ◽  
Intestinal Type Adenocarcinoma ◽  
The Mean

Abstract: Introduction: Malignant tumours of the sinonasal region – including those with invasion of the skull base – necessitate surgical resection. The majority of the cases give an opportunity to perform the procedure via minimally invasive, endoscopic approach, without external, craniofacial surgery. Aim: To assess our clinical experience in treating anterior skull base malignancies, performing minimally invasive endoscopic transcribriform resection. Method: Between February 2015 and July 2017, four male and one female patient underwent minimally invasive, endoscopic skull base procedure. The mean age was 64.6 years (59–70, median: 66). Every surgery was performed via transnasal, endoscopic transcribriform approach. In two cases Kadish C esthesioneuroblastomas, while in one case a T3N0 sinonasal non-differentiated carcinoma, a T1N0 intestinal type adenocarcinoma and a T4N0 squamous cell carcinoma was the indication of surgery, respectively. Results: The mean follow-up time was 22.8 months, between 14 and 46 months. Intraoperative complications did not occur during the procedures. Regarding the postoperative period, liquorrhoea and pneumocephalus occurred in one case. Complications were solved with lumbar drainage. During follow-up, neither residual nor recurrent tumour was observed in our patients. Conclusion: Endoscopic transcribriform resection of the skull base malignancies is a safe and viable alternative to the traditional open approach. Orv Hetil. 2019; 160(40): 1584–1590.

scholarly journals Laparoscopic Trans-Abdominal Retromuscular (TARM) Repair for Ventral Hernia: A Novel, Low-Cost Technique for Sublay and Posterior Component Separation

2019 ◽  
Vol 44 (4) ◽  
pp. 1081-1085 ◽  
Author(s):  
Ashwin A. Masurkar
Keyword(s):  
Ventral Hernia ◽  
Low Cost ◽  
Operating Time ◽  
Rectus Sheath ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Mesh Placement ◽  
Posterior Component Separation ◽  
Posterior Rectus Sheath ◽  
Midline Closure

Abstract Background The complications of intraperitoneal onlay mesh repair for ventral hernia has favored sublay mesh placement like open Rives–Stoppa repair (ORS). There was a need for low-cost laparoscopic trans-abdominal repair using a polypropylene mesh (PPM) with sublay, midline closure and addition of posterior component separation (PCS) by transversus abdominis release (TAR). Methods The techniques used three or six operating ports with triangulation. After adhesiolysis, a transverse incision was made on the peritoneum (P) and posterior rectus sheath (PRS). The retromuscular space was developed by raising a P-PRS flap. Midline closure was performed with No. 1 polydioxanone, and a PPM was placed in sublay, followed by closure of defect and P-PRS incision. For large hernias with divarication; myo-fascial medialization using PCS-TAR aided low-tension midline closure. Results Eighty-nine patients were operated from 2010 to 2019, 26 primary ventral; 63 incisional; and 22 recurrent hernias. Of the primary, 21 were umbilical, one Spigelian and four epigastric hernias. The incisional group had 57 patients with lower midline scars (C-section 25, open tubal ligation 15, abdominal hysterectomy 17), five lateral (appendicectomy), one post-laparotomy. The mean age, male/female sex ratio and BMI were 41.23 years, 1:10.1 and 29.2 kg/m2, respectively. Mean defect and mesh area were 110 cm2 and 392 cm2. Mean operating time was 192 min. Conversion to open, mesh infection and recurrence rates were 3.4%, 1.1% and 5.62%. Conclusion Laparoscopic TARM with PPM in sublay avoids mesh–bowel contact. It provides midline closure and PCS-TAR within the same port geometry with results comparable with ORS.

Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases

2019 ◽  
Vol 55 (3) ◽  
pp. 152-159 ◽  
Author(s):  
Claire Deroy ◽  
Harriet Hahn ◽  
Camille Bismuth ◽  
Guillaume Ragetly ◽  
Eymeric Gomes ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Abdominal Ultrasound ◽  
Abdominal Discomfort ◽  
Transversus Abdominis ◽  
Barbed Suture ◽  
Wound Complications ◽  
Minimally Invasive Surgical ◽  
Invasive Surgical Approach ◽  
Seromuscular Layer ◽  
Transversus Abdominis Muscle

ABSTRACT The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19–43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6–36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.

Decision Making in Ventral Hernia Repair: Minimally Invasive Surgery or Open Approach

2018 ◽  
Vol 227 (4) ◽  
pp. S98
Author(s):  
Kathryn Schlosser ◽  
Michael R. Arnold ◽  
Javier Otero ◽  
Tanushree Prasad ◽  
Paul D. Colavita ◽  
...  
Keyword(s):  
Decision Making ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Invasive Surgery ◽  
Ventral Hernia Repair ◽  
Open Approach

Minimally Invasive Multidisciplinary Approach to Chronic Giant Inguinoscrotal Hernias

2019 ◽  
Vol 26 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Zachary Sanford ◽  
Adam S. Weltz ◽  
Devinder Singh ◽  
Robert Hanley ◽  
David Todd ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Multidisciplinary Approach ◽  
Botulinum Toxin A ◽  
Transversus Abdominis ◽  
Transversus Abdominis Release ◽  
Large Space ◽  
Mesh Placement ◽  
Groin Hernias ◽  
Access Technique ◽  
Abdominal Compartment

Background. Giant inguinoscrotal hernias (GIH) are defined as groin hernias extending below the mid-thigh when standing, often significantly encumbering activities of daily living. To date, there are no reports utilizing the combination of progressive pneumoperitoneum (PPP), botulinum toxin A injection (BTI), and enhanced view-totally extraperitoneal (eTEP) technique for GIH repair. In this report, we present 2 such cases of this unique minimally invasive multidisciplinary approach to address GIH. Series Presentation. Two individuals with lifelong complaints of GIH presented for elective hernia repair, each with significant morbidity relating to their pathology and profound loss of abdominal domain. Four weeks prior to surgery, BTI was administered to the lateral abdominal compartment muscles to facilitate regional paralysis, followed by PPP to develop larger intraabdominal domain. Utilizing the eTEP access technique and transversus abdominis release, a wide retromuscular dissection was performed to aid in the increase of intraabdominal domain and to develop a large space for mesh placement. Reconstruction including partial scrotectomy and scrotoplasty using adjacent tissue transfer technique was completed. Both patients tolerated the procedures well without recurrence in the first postoperative year. Conclusion. In this article, we present the first series of GIH patients undergoing combined PPP, BTI, and eTEP access approach to retromuscular dissection. This multidisciplinary approach to patient care has proven both safe and effective.

scholarly journals A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

2020 ◽  
Author(s):  
Rui Tang ◽  
Huiyong Jiang ◽  
Weidong WU ◽  
Tao Wang ◽  
Mengxiang Meng ◽  
...  
Keyword(s):  
Ventral Hernia ◽  
Intraoperative Complications ◽  
Mesh Fixation ◽  
Transversus Abdominis ◽  
Intraperitoneal Onlay Mesh ◽  
Patient Demographics ◽  
Onlay Mesh ◽  
Sublay Repair ◽  
Space Separation ◽  
Ventral Hernias

Abstract Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia.Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

scholarly journals A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rui Tang ◽  
Huiyong Jiang ◽  
Weidong Wu ◽  
Tao Wang ◽  
Xiangzhen Meng ◽  
...  
Keyword(s):  
Ventral Hernia ◽  
Intraoperative Complications ◽  
Mesh Fixation ◽  
Transversus Abdominis ◽  
Intraperitoneal Onlay Mesh ◽  
Patient Demographics ◽  
Onlay Mesh ◽  
Sublay Repair ◽  
Space Separation ◽  
Ventral Hernias

Abstract Background For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed. Results ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23 and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia. Conclusion ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.

Sign in / Sign up

Export Citation Format

Share Document