Feasibility, safety, and reproducibility of robotic assisted TAPP inguinal hernia repair: a clinical report of 100 inguinal hernia repairs
Andrew S. Iraniha, M.D., F.A.C.S.
Newport Beach, California, USA
Conventional laparoscopic TAPP inguinal hernia repair is an established alternative to open hernia repair given equivalent outcomes and decreased post-operative pain and faster recovery. It is, however, technically very challenging due to requirement for advanced laparoscopic skills such as intra-corporeal suturing. Application of the da Vinci robotic surgical platform has the potential to overcome these challenges. This report describes the preliminary clinical outcomes of initial 50 patients with bilateral inguinal hernias who underwent robotic assisted TAPP repair to demonstrate the feasibility, safety and reproducibility of this procedure.
100 inguinal hernias in 50 consecutive patients were repaired with 3 D mesh (Bard) using daVinci(®) Si Surgical System (Intuitive Surgical, Sunnyvale, CA). The docking time, console time and total procedure time were recorded. A pain survey, using universal pain assessment tool was sent to the patients to record post-operative pain, narcotic use and time of return to work and exercise. Follow-up was done for 3 months.
47 men and 3 women with bilateral inguinal hernias underwent robotic assisted TAPP repair with mesh. Four out of 100 inguinal hernias were recurrent and the rest were initial diagnosis. The average docking, console, and total operation time were 4.5, 69 and 100 minutes, respectively. There were no intraoperative or post-operative complications. Only 5 of patients reported pain in the groin and 2 reported mild swelling in the groin region. Post-operative pain, recovery time and return to work were comparable to the laparoscopic experience.
In experienced hand, robotic assisted TAPP inguinal hernia repair appears to be a technically feasible, reproducible and safe alternative for minimally invasive inguinal hernia repair. There are also other potential benefits for this approach compare to the laparoscopic one, including, even less pain, bruising and swelling in the groin region, less recurrence, increase ability to repair the larger hernia and performing this technique in patients with higher BMI. Prolonged follow-up and careful prospective investigation are required to confirm its potential role as a valid alternative to standard laparoscopic approach.