Preoperative Considerations Prior to Minimally Invasive Ventral Incisional Hernia Repair

Abstract

Minimally invasive as opposed to open ventral hernia repair has been proven to reduce surgical site infection and hospital length of stay with similar long-term outcomes. Despite this, less than one-third of all ventral hernias are being repaired with a minimally invasive technique. While not all patients with a ventral hernia will benefit from minimally invasive repair, the majority will. This is because most patients develop ventral incisional hernias due in part to their comorbid conditions (e.g., obesity, poorly controlled diabetes) which increase the risk of surgical site infection and adversely affect wound healing. The slow adoption of minimally invasive ventral hernia repair is related to surgeon skill and experience. The robotic platform can bridge the gap to allow for more surgeons to successfully perform a minimally invasive procedure. In combination with preoperative optimization, minimally invasive surgery provides the best short-term outcomes with equivalent long-term outcomes and the robotic platform can potentially increase the proportion of patients eligible for minimally invasive treatment. Safety, efficacy, and effectiveness randomized controlled trials are needed to validate these assumptions and should be completed prior to widespread adoption of the robotic platform for ventral hernia repair.