Abstract: A Retrospective Comparison of Robot-Assisted Ventral Hernia Repair with Conventional Techniques

Abstract

INTRODUCTION: Although robot-assisted surgery is no longer considered to be a “novel” technology, its application to hernia repair remains relatively new. As a result, there is limited data available in the literature regarding robot-assisted ventral hernia repair. The purported benefits of robot-assisted surgery include high definition three-dimensional visualization, improved surgeon ergonomics, and 6-degrees of freedom with range of motion. The cited potential drawbacks include increased expense and longer operative/anesthesia times, but these have not been definitively proven. We therefore seek to compare operative details and patient outcome data among patients undergoing open, laparoscopic, robot-assisted ventral hernia repairs. METHODS: Institutional Review Board approval was obtained (Study Number: 16-00011). A retrospective study was performed of all patients who underwent elective open, laparoscopic, and robot-assisted ventral hernia repair at a single institution in 2015. Procedure-related details such as anesthesia and operative times, length of stay, use of mesh, primary closure of the fascia, and postoperative complications were compared between groups. Those patients undergoing emergent procedures or a separate procedure simultaneous with ventral hernia repair were excluded. RESULTS: 160 patients were included in the study. Mean age was 56.7 years. Mean BMI was 30.1 kg/m2. 138 patients (81%) had a history of previous intra-abdominal surgery. Hernia was recurrent in 32 (20%) of the cohort. Twenty seven patients (16.9%) underwent laparoscopic hernia repair, 110 (68.7%) underwent open repair, and 23 (14.4%) patients underwent robot-assisted repair. Robot-assisted repairs were associated with significantly increased anesthesia and operative times (p<0.0001). There was no significant difference in length of hospital stay, complications (which included seromas, hematomas, abscesses, pneumonia, dehiscence, small bowel obstruction, and mesh infections), or hernia recurrence between robot-assisted procedures and laparoscopic or open repairs. CONCLUSION: These preliminary data suggest that although robot-assisted ventral hernia repairs are associated with increased anesthesia and operative times, the outcomes with regard to length of hospital stay, safety profile, and risk of recurrence are comparable to those of more traditional hernia repair methods. Therefore application of robotic technology to ventral hernia repair is both safe and feasible, although larger, prospective, multi-center studies are necessary before definitive conclusions regarding this novel application are drawn.