Fong_Robotic General Surgery, 1e

First page Previous page 26 Next page Last page

SECTION 2 • Discipline-Based Practice - General Surgery

Kaplan-Meier curve for 5-year recurrence, by year of surgery ( n = 644)

Kaplan-Meier curve for 5-year recurrence, by type of surgery ( n = 644)

100

2014 or earlier 2015 2016 2017 2018 2019 2020

rIPOM rTAPP rRS rTAR

Freedom from Recurrence (%)

Log-rank P -value: .30

Log-rank P -value: .03

Years

2014 or earlier 2015 2016

rIPOM rTAPP rRS

196 (100%) 152 (100%) 153 (100%) 138 (100%)

46 (100%) 101 (100%) 131 (100%) 86 (100%) 109 (100%) 120 (100%) 51 (100%)

158 (98.8%) 135 (97.8%) 98 (98.2%) 76 (100%)

151 (95.6%) 120 (96.4%) 38 (98.2%) 36 (100%)

38 (100%) 81 (96.4%) 99 (97.1%) 71 (100%) 89 (98.9%) 93 (100%) 0

139 (94.3%) 90 (95.6%) 18 (98.2%) 6 (100%)

56 (94.3%) 29 (93.3%) 0 1(100%)

94 (94.3%)

37 (97.4%) 75 (91.6%) 96 (96.1%) 69 (98.6%) 72 (98.9%)

37 (97.4%) 73 (90.4%) 90 (94%) 57 (98.6%)

36 (97.4%)

36 (97.4%) 52 (89.1%)

68 (93.3%) 10 (98.2%) 3 (100%)

70 (89.1%) 73 (93%)

0 0 0 0 0

2017 2018 2019 2020

Number at risk rTAR

0 0 0 0

0 0 0

0 0

Number at risk

FIGURE 7.5 Kaplan-Meier curve showing 5-year recurrence rates after robotic ventral hernia repair (rv-TAPP, r-Rives, or r-TARUP). Numbers before the parentheses represent the number of patients at risk based on follow-up. Percentages within the parentheses represent the freedom from recurrence rate. (Baur J, Ramser M, Keller N, et al. Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients (vol 92, pg 15, 2021). Chirurg . 2021;92(suppl 1):27.)

This can be done via a laparoscopic or robotic approach, and the technique for fixing includes reduction of bowel and primary repair of the defect in the posterior sheath. If the defect cannot be closed primarily, an intraperito neal mesh can be used to cover the defect. CONCLUSIONS The robotic preperitoneal surgical approach for VHR is safe and effective. The preperitoneal placement of mesh requires less traumatic fixation and might prevent its contact with the viscera and, therefore, formation of adhesions, erosions, and fistulas. REFERENCES 1. Coakley KM, Sims SM, Prasad T, et al. A nationwide evaluation of robotic ventral hernia surgery. Am J Surg . 2017;214(6):1158-1163. 2. Pauli EM, Rosen MJ. Open ventral hernia repair with component separation. Surg Clin North Am . 2013;93(5):1111-1133. 3. Pahwa HS, Kumar A, Agarwal P, Agarwal AA. Current trends in laparoscopic groin hernia repair: a review. World J Clin Cases . 2015;3(9):789-792. 4. Donkor C, Gonzalez A, Gallas MR, Helbig M, Weinstein C, Rodriguez J. Current perspectives in robotic hernia repair. Robot Surg . 2017;4:57-67. 5. Pereira X, Lima DL, Friedmann P, et al. Robotic abdominal wall repair: adoption and early outcomes in a large academic medical cen ter. J Robot Surg . 2022;16(2):383-392. 6. Podolsky D, Novitsky Y. Robotic inguinal hernia repair. Surg Clin North Am . 2020;100(2):409-415. 7. Halm JA, de Wall LL, Steyerberg EW, Jeekel J, Lange JF. Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg . 2007;31(2):423-429; discussion 430. 8. Gray SH, Vick CC, Graham LA, Finan KR, Neumayer LA, Hawn MT. Risk of complications from enterotomy or unplanned bowel resection during elective hernia repair. Arch Surg . 2008;143(6):582-586.

TABLE 7.3 Extraperitoneal Robotic Ventral Hernia Repair Complications

Complications

Incidence

eTEP

Seroma

2.4%-18%

Retromuscular hematoma

0%-3%

Surgical-site infection

1.3%-3%

Hematoma

1.7%-7%

Posterior layer dehiscence

1%-3.4%

Recurrence

0%-3%

TAPP

Bowel injury

0.50%

Urinary retention

0.80%

Surgical-site infection

Seroma

Hematoma

Recurrence

Ileus

1.60%

TARM

Paralytic ileus

9.50%

Mesh infection

1.10%

Recurrence

5.60%

Made with FlippingBook - Online catalogs