Feasibility of Robotic-Assisted Transabdominal Preperitoneal Ventral Hernia Repair

Abstract

Purpose: Published results from mesh placement in the preperitoneal space between the posterior fascia and peritoneum for ventral hernia repair are limited. We describe our initial experience regarding the feasibility of a robotic-assisted transabdominal preperitoneal (rTAPP) ventral hernia repair. Methods: The study is a retrospective review and descriptive analysis of consecutive and prospectively collected data regarding rTAPP ventral hernia repair conducted by a single surgeon between 2014 and 2016. Results: Fifty-four consecutive rTAPP ventral hernia repairs were performed, and all but two cases were elective. Indications were: 41 primary ventral, 5 incisional, 3 lumbar, 2 Spigelian, 1 recurrent incisional, 1 combined flank and inguinal, and 1 combined primary ventral and inguinal. The mean operative time was 73 minutes (range 25–217 minutes). The average hernia defect was 9.7 cm2, whereas the average size of synthetic mesh was 178 cm2. Forty-six cases were completed through an rTAPP approach, and 8 were via partial rTAPP due to multiple peritoneal defects. Estimated blood loss was 5–10 mL. Forty-nine patients were treated on an outpatient basis. Two complications occurred: symptomatic seroma requiring aspiration in the office and rectus sheath hematoma requiring hospital readmission and blood transfusion. Conclusions: Our study results support the safe and effective placement of mesh in the preperitoneal space via the use of robotic technology, and they represent the largest single-surgeon series of robotic-assisted TAPP ventral hernia repair. Large, multicenter prospective trials could further elucidate the potential benefits and the long-term outcomes from this approach.