Abstract
Background
The management of ventral incisional hernias (VIH) has undergone many iterations over the last 5 years due to evolution in surgical techniques and advancement in robotic surgery. Four general principles have emerged: mesh usage, retromuscular mesh placement, primary fascial closure, and usage of minimally invasive techniques when possible. The application of robotic retromuscular repairs in VIH allow these principles to be applied simultaneously. This qualitative review attempts to answer what robotic retromuscular repairs are described, which patients are selected for these techniques, and what are current outcomes.
Methods
Using the key words: “robotic retromuscular repair”, “robotic Rives Stoppa”, and “robotic transversus abdominis release”, a PubMed search of articles written up to December 2019 was critically reviewed.
Results
44 articles were encountered, 9 high-quality articles were analyzed for this manuscript. Level of evidence ranged from 2B to 2C. Robotic TAR patients had BMI of 33 kg/m2, defect sizes ranging from 7–14 cm wide to 12–19 cm long, longer OR times, no difference in surgical site events, and shorter length of stay (LOS). The techniques to perform robotic Rives Stoppa (RS) were heterogeneous; however, extended totally extraperitoneal (ETEP) approach is most described. Defect width for RS repairs ranged 4–7 cm and LOS was less than 1 day. Complication rates were low, there is no long-term data on hernia recurrence, and information on cost is limited.
Conclusion
In short-term follow-up, robotic retromuscular repairs show promise that VIH can be repaired with intramuscular mesh, few complications, and shorter LOS. Data on hernia recurrence, long-term complications, and rigorous cost analysis are needed to demonstrate generalizability.
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References
Liang MK, Holihan JL, Itani K et al (2017) Ventral Hernia Management: Expert Consensus Guided by Systematic Review. Ann Surg 265(1):80–89
Kockerling F, Simon T, Adolf D et al (2019) Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients. Surg Endosc 33(10):3361–3369
Van Hoef S, Tollens T (2019) Primary non-complicated midline ventral hernia: is laparoscopic IPOM still a reasonable approach? Hernia : The J Hernias and Abdominal Wall Surgery 23(5):915–925
Parker SG, Halligan S, Liang MK et al (2020) International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair. Br J Surg 107(3):209–217
Luijendijk RW, Hop WC, van den Tol MP et al (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343(6):392–398
Stoppa RE, Rives JL, Warlaumont CR, Palot JP, Verhaeghe PJ, Delattre JF (1984) The use of Dacron in the repair of hernias of the groin. The Surgical clinics of North America 64(2):269–285
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204(5):709–716
Holihan JL, Nguyen DH, Nguyen MT, Mo J, Kao LS, Liang MK (2016) Mesh Location in Open Ventral Hernia Repair: A Systematic Review and Network Meta-analysis. World J Surg 40(1):89–99
Holihan JL, Askenasy EP, Greenberg JA, et al. (2016) Component Separation vs Bridged Repair for Large Ventral Hernias A Multi-Institutional Risk Adjusted Comparison, Systematic Review, and Meta-Analysis. Surg Infect (Larchmt)17(1): 17–26
Stoikes N, Webb D, Powell B, Voeller G (2013) Preliminary report of a sutureless onlay technique for incisional hernia repair using fibrin glue alone for mesh fixation. The American surgeon 79(11):1177–1180
Butler CE, Campbell KT (2011) Minimally invasive component separation with inlay bioprosthetic mesh (MICSIB) for complex abdominal wall reconstruction. Plast Reconstr Surg 128(3):698–709
Bueno-Lledo J, Torregrosa A, Ballester N et al (2017) Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 21(2):233–243
Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31(1):324–332
Carbonell AM, Warren JA, Prabhu AS et al (2018) Reducing Length of Stay Using a Robotic-assisted Approach for Retromuscular Ventral Hernia Repair: A Comparative Analysis From the Americas Hernia Society Quality Collaborative. Ann Surg 267(2):210–217
Coccolini F, Catena F, Pisano M et al (2015) Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg (London, England) 18:196–204
Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair 14 years of patient data accrual. Surg Endosc 21(3):378–386
Zeng X, Zhang Y, Kwong JS et al (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evidence-based Med 8(1):2–10
Agha RA, Barai I, Rajmohan S et al (2017) Support for reporting guidelines in surgical journals needs improvement: A systematic review. Int J Surg (London, England) 45:14–17
Halpern DK, Howell RS, Boinpally H, Magadan-Alvarez C, Petrone P, Brathwaite CEM (2019) Ascending the Learning Curve of Robotic Abdominal Wall Reconstruction. Journal of the Society of Laparoendoscopic Surgeons 23(1):e2018–00084
Belyansky I, Reza Zahiri H, Sanford Z, Weltz AS, Park A (2018) Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair. Hernia 22(5):837–847
Lu R, Addo A, Ewart Z, et al. Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs. Surgical endoscopy. 2019.
Gokcal F, Morrison S, Kudsi OY (2019) Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications. Hernia 23(2):375–385
Kudsi OY, Gokcal F (2019) Lateral approach totally extraperitoneal (TEP) robotic retromuscular ventral hernia repair. Hernia. https://doi.org/10.1007/s10029-019-02082-9
Daes J (2012) The enhanced view-totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26(4):1187–1189
Martin-Del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2018) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32(2):840–845
Bittner JGT, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32(2):727–734
Halka JT, Vasyluk A, DeMare AM, Janczyk RJ, Iacco AA (2018) Robotic and hybrid robotic transversus abdominis release may be performed with low length of stay and wound morbidity. Am J Surg 215(3):462–465
Bittner R, Bain K, Bansal VK et al (2019) Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A. Surg Endosc 33(10):3069–3139
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Dr. Santos, Dr. Ledet, Ms. Limmer, and Ms. Gibson have no conflicts or interest or financial ties to disclose.
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Santos, D.A., Limmer, A.R., Gibson, H.M. et al. The current state of robotic retromuscular repairs—a qualitative review of the literature. Surg Endosc 35, 456–466 (2021). https://doi.org/10.1007/s00464-020-07957-y
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DOI: https://doi.org/10.1007/s00464-020-07957-y