V10-12 ROBOTIC ASSISTED REPAIR OF POST-ILEAL CONDUIT PARASTOMAL HERNIA: TECHNIQUE AND OUTCOMES

Abstract

You have accessJournal of UrologyLower Tract Reconstruction (V10)1 Sep 2021V10-12 ROBOTIC ASSISTED REPAIR OF POST-ILEAL CONDUIT PARASTOMAL HERNIA: TECHNIQUE AND OUTCOMES Alex Xu, Nabeel Shakir, Min Jun, and Lee Zhao Alex XuAlex Xu More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Min JunMin Jun More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002061.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ileal conduits remain the primary form of urinary diversion after cystectomy, and parastomal hernia (PSH) is not an infrequent postoperative complication with considerable recurrence rates after open surgical repair, leading to both functional and cosmetic deficits. There is a paucity of literature examining robotic assisted laparoscopic parastomal hernia repair (RAL-PHR). We report a novel method of PSH repair using the Da Vinci Single Port (SP) robotic system. METHODS: We retrospectively reviewed 4 patients who underwent RAL-PHR by a single surgeon (LCZ) from June 2018 to February 2020. Variables included patient demographics, intraoperative considerations, and post-operative course. RAL-PHR is performed using a 3cm incision in the contralateral upper quadrant for the robotic trocar. The hernia is freed from the fascial defect and the defect tacked to the fascial edge. Mesh is then approximated to the fascial edges with a portion excised to tailor to the conduit. RESULTS: A total of 4 patients underwent RAL-PHR. The 3 most recent cases utilized the SP robot. Median age was 74.4 (range: 69.0–76.9) and median BMI was 28.6 (26.5–43.2). All patients underwent cystectomy for bladder cancer and the median time from index operation to PSH repair was 47.3 (40.4–11.48) months. One patient had a prior failed repair at an outside institution.Median operative time was 3.9 (2.6–8.7) hours, median estimated blood loss was 50 (10–100) cc, mesh was used in 3 of the 4 cases, and no intraoperative complications were reported. One patient underwent concurrent ureteral reimplant, abdominal wall reconstruction, and stoma revision and another patient had concurrent repair of an incisional hernia. Median length of stay was 1 day and 1 post-operative complication greater than Clavien 2 was reported. At median follow-up of 10.25 (3.2–14.4) months, no recurrences were reported. CONCLUSIONS: RAL-PHR using the SP system maximizes advantages of laparoscopic repair including providing a clear view of the hernia, fascial defect, and ileal conduit as well as ease of mesh placement and decreased length of stay, morbidity, and recurrence rates. Additionally, the SP system allows for flexibility to perform concurrent procedures such as ureteral reimplant and stoma revision and leads to safer takedown of adhesions through the use of fewer incisions versus the Xi system. Our data suggests that RAL-PHR is a safe and effective alternative technique to open and laparoscopic PSH repair with several additional benefits. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e758-e758 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Xu More articles by this author Nabeel Shakir More articles by this author Min Jun More articles by this author Lee Zhao More articles by this author Expand All Advertisement Loading ...