Robotic Inguinal Hernias Performed at a Community Hospital: a Case Series of 292 Patients

Background: Robotic inguinal hernia repair has become more common and has replaced the laparoscopic approach in many hospitals in the US. We present a retrospective review of 416 consecutive inguinal hernia repairs using the robotic transabdominal preperitoneal approach in an academic community hospital. Methods: This is a retrospective review of 416 consecutive robotic inguinal hernia repairs in 292 patients performed from October 2015 to March 2021 by two surgeons. The demographics, intra-operative findings, and postoperative outcomes were analyzed. The results for patients during the initial 25 cases (which were considered to be during the learning curve for each surgeon) were compared to their subsequent cases. A multivariable logistic regression analysis was used to determine independent risk factors for postoperative complications. Results: Overall, 292 patients underwent 416 inguinal hernia repairs, of whom 124 (42.5%) had bilateral hernias. The mean age was 61 years and the mean BMI was 26.96 kg/m2. Of the bilateral hernias, 31.5% were unsuspected pre-operatively. Femoral hernias were found in 20.5% of patients, including in 18.4% of men, which were also unsuspected. Post-operatively, 89% of patients were discharged home the same day. The most common post-operative complication was seroma, which occurred in 13%. Three patients required re-intervention: one had deep SSI (infected mesh removal), one had a needle aspiration of a hematoma (SSORI), and one was operated on for small bowel volvulus related to adhesions. On short-term follow-up, there was only one early recurrence (0.2%). When cases during the learning curve period were compared to subsequent surgeries, there were no major differences in post-operative complications or operating time. Patients aged ≥55 years had a 2.456-fold (p=0.023) increased odds of post-operative complications. Conclusions: Robotic inguinal hernia repair can be safely performed at a community hospital with few early post-operative complications and very low early recurrence rates. The robotic approach also allows for the detection of a significant number of unsuspected contralateral inguinal hernias and femoral hernias, especially in male patients. Age ≥55 years was an independent risk factor for postoperative complications.

Robotic inguinal hernia repair (rTAPP) – A series of 300 cases

Objective While inguinal hernia repair using mesh is the recommended standard for most patients, minimal invasive techniques experienced a prolonged process until broad acceptance and sufficient expertise. Lately, a reluctance towards the integration of robotic hernia repair as a standard procedure is observed in Europe compared to the US. Nevertheless, robotic technology is a powerful tool for increasing quality in standardized procedures. We present a large case series of inguinal hernias repaired by robotic surgery. Methods All consecutive patients receiving a robotic inguinal hernia repair with a transabdominal approach (rTAPP) in the first 18 months (May 2018 up to October 2019) after introduction of the DaVinci Xi system at our institution were included in this study. Results Overall, 302 groin hernias in 225 patients were operated in the defined period. 77 patients presented with bilateral hernias. Mean age of patients was 58.7 years, 87.6% were men. Mean BMI 25.5kg/m2. Nearly half of all operations were teaching operations making use of the available double consoles. While in the first 6 months only 20.0% of operations were teaching procedures, the rate increased to 60.3% in the last 6 months of the observation period. While overall 35.6% of procedures were performed as day-surgery, the rate varied over the course of the study with 35.6% in the first 6 months, 46.0% in the second and 33.3% in the last 6 months. Operation time was 82.6min. (range 40-186) with 72min. (range 40-186) for unilateral repairs and 101.3min. (range 52-169) for bilateral repairs. Further subgroup analysis showed that in bilateral repairs in primary hernias teaching vs. no-teaching operations differed only marginally in time (108.9min., range 66-149 vs. 91.6min., range 52-159). Follow-up data was available for 93.8% of patients. There were no cases of recurrence; two patients experienced postoperative pain lasting more than 30 days. Seroma was observed in 8.9%, haematoma in 4.4% cases. Urinary retention occurred in 3.6% of patients, PE in 0.4%, DVT in 0.4%, epididymitis in 3.1%. Conclusion Robotic inguinal hernia repair is an outstanding and safe procedure. The operative accuracy of the system is impressive. The availability of two consoles makes it an ideal teaching tool, allowing to train residents in inguinal hernia repair, in a high standard of safety and with good outcomes.