Lateral single-dock robot-assisted retro-rectus ventral hernia repair (rTARUP/rTARM): observational study on long-term follow-up

Abstract

Robot-assisted surgery for ventral hernias has gained popularity among surgeons in hospitals equipped with robotic platforms, despite the limited availability of high-level prospective data. Moreover, research on long-term outcomes of ventral hernia repair remains particularly challenging. This study aims to evaluate the long-term outcomes of patients operated for a ventral hernia with a robot-assisted repair using a self-fixating retro-rectus synthetic mesh with a lateral docking transabdominal approach (rTARUP/rTARM). The study is a mono-centric cohort study of a consecutive series of patients with a midline ventral hernia, including both primary and incisional hernias, treated with a robot-assisted lateral approach utilizing a self-fixating retro-rectus mesh. The patients were identified from a prospective online registry database and subsequently contacted for follow-up assessment. Among the 526 ventral hernia repairs registered between September 2016 and December 2019, 198 patients met the inclusion criteria for this study. Long-term follow-up with valid data on recurrence was achieved in 162 patients (82%). Valid data from the EuraHS Quality-of-Life (QoL) questionnaire were available for 111 patients (56%). The recurrence rate after rTARUP, with a median follow-up of 4.5 years, was 3.7% in 162 patients with valid recurrence data. The rTARUP procedure can be performed with a low complication rate of 6.1% and favorable long-term results on QoL. The robot-assisted transabdominal retromuscular approach is a safe and effective surgical technique with a low recurrence rate and favorable QoL scoring over time. It combines the favorable retro-rectus mesh position with minimal invasive surgery, however care should be taken on adopting the technique too early in the robot-training pathway since it does pose some anatomic challenges and requires advanced robotic skills.