R. Huang1, L. Policastro1, P. J. Chung2, H. Patel2, A. Schwartzman2, R. Lee2, G. Sugiyama2 1SUNY Downstate College Of Medicine,Brooklyn, NEW YORK, USA 2SUNY Downstate Medical Center,Department Of Surgery,Brooklyn, NEW YORK, USA
Introduction: Laparoscopic inguinal hernia repair was introduced in the 1990s and has been widely adopted. Many studies have shown that the transabdominal pre-peritoneal (TAPP) and totally extra-peritoneal (TEP) approaches to inguinal hernia repair have low recurrence rates and allow for early return to activity due to decreased pain. The robotic surgical platform improves upon standard laparoscopic approaches, providing enhanced dexterity and 3D viewing. Robotic inguinal hernia repair has been previously reported en-passant with prostatectomy, but has not been studied as a stand-alone procedure. We report one of the first case series of stand-alone robotic TAPP inguinal hernia repair at an inner-city academic medical center.
Methods: From December 2013 to June 2014, 26 robotic TAPP inguinal hernia repairs were performed at a single institution. We employed a three port approach, with a camera port at the umbilicus and two 8 mm lateral ports roughly 2 cm above the umbilicus. Patient characteristics, operative times, complications, and hernia recurrence were assessed. Data were compiled retrospectively.
Results: Twenty-six robotic TAPP inguinal hernia repairs were performed, of which seven were bilateral. Twenty-four patients were male and two were female. The mean age of the patients was 59.6 ± 11.2 years. The mean BMI of the patients was 26.3 ± 3.4. The mean incision-to-closure time was 127 ± 42 minutes. The mean robotic operation time was 82 ± 37 minutes. The mean robot docking time was 6 ± 3 minutes. Seven patients had scrotal hernias, three presented with incarcerated inguinal hernias, and an additional two had large hernia sacs. On follow-up, 4 of 26 patients (15%) had postoperative hematomas, while 3 patients (12%) had postoperative urinary retention. One patient (4%) returned with a recurrent hernia. No scrotal hernia patients presented with recurrence.
Conclusion: We present a case series of robotic TAPP inguinal hernia repairs at an inner-city institution and conclude that the procedure is feasible and safe for both routine herniorrhaphy and in advanced scrotal cases. Recurrence and morbidity were low during the early learning curve. Large scrotal and incarcerated inguinal hernias were repairable using the robotic approach. Further prospective study is needed to determine whether robotic inguinal hernia repair should be broadly adopted.