Feasibility of Robotic-Assisted Transabdominal Preperitoneal Ventral Hernia Repair

Abstract

Purpose: Published results from mesh placement in the preperitoneal space between the posterior fascia and peritoneum for ventral hernia repair are limited. We describe our initial experience regarding the feasibility of a robotic-assisted transabdominal preperitoneal (rTAPP) ventral hernia repair.

Methods: The study is a retrospective review and descriptive analysis of consecutive and prospectively collected data regarding rTAPP ventral hernia repair conducted by a single surgeon between 2014 and 2016.

Results: Fifty-four consecutive rTAPP ventral hernia repairs were performed, and all but two cases were elective. Indications were: 41 primary ventral, 5 incisional, 3 lumbar, 2 Spigelian, 1 recurrent incisional, 1 combined flank and inguinal, and 1 combined primary ventral and inguinal. The mean operative time was 73 minutes (range 25-217 minutes). The average hernia defect was 9.7 cm², whereas the average size of synthetic mesh was 178 cm². Forty-six cases were completed through an rTAPP approach, and 8 were via partial rTAPP due to multiple peritoneal defects. Estimated blood loss was 5-10 mL. Forty-nine patients were treated on an outpatient basis. Two complications occurred: symptomatic seroma requiring aspiration in the office and rectus sheath hematoma requiring hospital readmission and blood transfusion.

Conclusions: Our study results support the safe and effective placement of mesh in the preperitoneal space via the use of robotic technology, and they represent the largest single-surgeon series of robotic-assisted TAPP ventral hernia repair. Large, multicenter prospective trials could further elucidate the potential benefits and the long-term outcomes from this approach.

Keywords: preperitoneal mesh; robotics; ventral hernia.