Robotic General Surgery


CHAPTER 6 • Robotic Transabdominal Preperitoneal Inguinal Hernia Repair With Mesh

CONCLUSIONS Robotic inguinal hernia repair via a transabdominal preperitoneal approach is a safe and well-tolerated pro cedure. It is a natural extension of traditional laparo scopic repairs with comparable short- and long-term outcomes. The robotic platform is enabling more sur geons to effectively accomplish this advanced minimally invasive technique with a high rate of success. REFERENCES 1. Vu JV, Gunaseelan V, Krapohl GL, et al. Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a popula tion-based study. Surg Endosc . 2019;33(2):486-493. 2. HerniaSurge Group. International guidelines for groin hernia man agement. Hernia . 2018;22(1):1-165. 3. Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful wait ing vs repair of inguinal hernia in minimally symptomatic men: a ran domized clinical trial. JAMA . 2006;295(3):285-292. 4. Huynh D, Fadaee N, Gök H, Wright A, Towfigh S. Thou shalt not trust online videos for inguinal hernia repair techniques. Surg Endosc . 2020;35(10):5724-5728. 5. Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med . 2004;350(18):1819-1827. 6. Prabhu AS, Carbonell A, Hope W, et al. Robotic inguinal vs transab dominal laparoscopic inguinal hernia repair: the RIVAL randomized clinical trial. JAMA Surg . 2020;155(5):380-387. 7. Huynh D, Feng X, Fadaee N, Gonsalves N, Towfigh S. Outcomes from laparoscopic versus robotic mesh removal after inguinal hernia repair. Surg Endosc . 2022;36(9):6784-6788. 8. Koch A, Edwards A, Haapaniemi S, Nordin P, Kald A. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg . 2005;92(12):1553-1558. 9. Daes J, Felix E. Critical view of the myopectineal orifice. Ann Surg . 2017;266(1):e1-e2. 10. Claus C, Furtado M, Malcher F, Cavazzola LT, Felix E. Ten golden rules for a safe MIS inguinal hernia repair using a new anatomical concept as a guide. Surg Endosc . 2020;34(4):1458-1464. 11. Valencia Morales DJ, Stewart BR, Heller SF, et al. Urinary retention following inguinal herniorrhaphy: role of neuromuscular blockade reversal. Surg Laparosc Endosc Percutan Tech . 2021;31(5):613-617. 12. AlMarzooqi R, Tish S, Huang LC, Prabhu A, Rosen M. Review of inguinal hernia repair techniques within the Americas hernia Society quality collaborative. Hernia . 2019;23(3):429-438.

invasive inguinal hernia repair include the ilioinguinal, iliohypogastric, genital branch of the genitofemoral, and the lateral cutaneous nerve of the thigh. Although it is rare, if a patient is observed in the immediate postopera tive period with extreme and new-onset pain in the groin region, the surgeon should consider immediate re-explo ration as nerve entrapment may be at play, in particular if penetrating fixation was utilized during the case. Recurrence Minimally invasive inguinal hernia repair is associated with low instance of hernia recurrence. Reported rates in the published literature are less than 5%. Recurrence is most often considered a failure in technique. The mech anisms of recurrence include the following 13 : l Incomplete lateral dissection: Increased potential for recurrence with herniation of peritoneum or retroper itoneal structures through the deep inguinal ring. l Inadequate coverage of defects: As stated previously, the minimum size of mesh utilized for repair should be 15 cm by 12 cm. Use of smaller mesh, particularly for relatively large defects will increase the potential for recurrence. l Mesh migration: For larger defects, mesh fixation can avoid mesh migration and hernia recurrence. It is our practice to fixate mesh at minimum to the ipsilateral Cooper ligament, with contralateral Cooper ligament fixation for direct defects. l Mesh eventration: Large defects (both direct and indirect) can predispose lightweight mesh to herni ate through the patched defect. Use of heavier-weight mesh has been shown to significantly reduce recur rence rates. l Inadequate dissection of myopectineal orifice: All aspects of the process of obtaining the critical view of the myopectineal orifice should be carefully assessed during the performance of any minimally invasive inguinal hernia repair. In particular, evaluation for cord lipomas should be carefully conducted to avoid the possibility of a retroperitoneal recurrence.

13. Claus C, Cavazolla LT, Furtado M, Malcher F, Felix E. Challenges to the 10 golden rules for a safe minimally invasive surgery (Mis) inguinal hernia repair: can we improve? Arq Bras Cir Dig . 2021;34(2):e1597. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

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