Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea

Abstract

Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.

Keywords: hernia surgery; inguinal hernia; robotic surgery.

Figure 1

Robotic-assisted TAPP inguinal hernia surgery trocar placement.

Figure 2

Robotic-assisted TAPP inguinal hernia surgery docking status.

Figure 3

Robotic-assisted TAPP hernia repair procedure. (A). Peritoneum dissection using monopolar curved scissors. (B). Mesh application using a tack on the pubic bone. (C). Hernia sac fixation using a tack on the pubic bone. (D). Reperitonization using a robotic arm.

Figure 3

Robotic-assisted TAPP hernia repair procedure. (A). Peritoneum dissection using monopolar curved scissors. (B). Mesh application using a tack on the pubic bone. (C). Hernia sac fixation using a tack on the pubic bone. (D). Reperitonization using a robotic arm.

Figure 4

Cumulative sum (CUSUM) analysis of console times for robotic-assisted TAPP inguinal hernia surgery. The x-axis indicates consecutive cases, and the y-axis indicates the CUSUM score for robot console times. The vertical line represents the inflection point that divides between the early and late phases.