Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release

Abstract

Background

Transversus abdominis release (TAR) has evolved as an effective approach to complex abdominal wall reconstructions. Although the role of robotics in hernia surgery is rapidly expanding, the benefits of a robotic approach for abdominal wall reconstruction have not been established well. We aimed to compare the impact of the application of robotics to the TAR procedure on the perioperative outcomes when compared to the open TAR repairs.

Methods

Case-matched comparison of patients undergoing robotic TAR (R-TAR) at two specialized hernia centers to a matched historic cohort of open TAR (O-TAR) patients was performed. Outcome measures included patient demographics, operative details, postoperative complications, and length of hospitalization.

Results

38 consecutive patients undergoing R-TAR were compared to 76 matched O-TAR. Patient demographics were similar between the groups, but ASA III status was more prevalent in the O-TAR group. The average operative time was significantly longer in the R-TAR group (299 ± 95 vs.. 211 ± 63 min, p < 0.001) and blood loss was significantly lower for the R-TAR group (49 ± 60 vs. 139 ± 149 mL, p < 0.001). Wound morbidity was minimal in the R-TAR, but the rate of surgical site events and surgical site infection was not different between groups. Systemic complications were significantly less frequent in the R-TAR group (0 vs. 17.1%, p = 0.026). The length of hospitalization was significantly reduced in the R-TAR group (1.3 ± 1.3 vs. 6.0 ± 3.4 days, p < 0.001).

Conclusions

In our early experience, robotic TAR was associated with longer operative times. However, we found that the use of robotics was associated with decreased intraoperative blood loss, fewer systemic complications, shorter hospitalizations, and eliminated readmissions. While long-term outcomes and patient selection criteria for robotic TAR repair are under investigations, we advocate selective use of robotics for TAR reconstructions in patients undergoing AWR.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Fitzgerald HL, Orenstein S, Poi MJ, Novitsky YW (2009) Transversus abdominis muscle release: a novel approach to posterior fascia release during retromuscular abdominal wall reconstructions. Abstracts of the 4th Joint Hernia Meeting of the American Hernia Society and European Hernia Society. September 9–12, 2009. Berlin, Germany. Hernia 2009; 13:104

  2. 2.

    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 204:709–716

  3. 3.

    Petro CC, Como JJ, Yee S et al (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429

  4. 4.

    Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232

  5. 5.

    Petro CC, Orenstein SB, Criss CN et al (2015) Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 210:334–339

  6. 6.

    Fayezizadeh M, Majumder A, Belyansky I, Novitsky YW (2016) Outcomes of retromuscular porcine biologic mesh repairs using transversus abdominis release reconstruction. J Am Coll Surg 223:461–468

  7. 7.

    Wang J, Majumder A, Fayezizadeh M et al (2016) Outcomes of retromuscular approach for abdominal wall reconstruction in patients with inflammatory bowel disease. Am Surg 82:565–570

  8. 8.

    Winder JS, Behar BJ, Juza RM et al (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223:271–278

  9. 9.

    Ballecer C, Parra-Davila E (2016) Robotic ventral hernia repair. In: Novitsky YW (ed) Hernia surgery—current principles. Springer, Switzerland, pp 273–286

  10. 10.

    Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332

  11. 11.

    Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278

  12. 12.

    Novitsky YW (2016) Posterior component separation via transversus abdominis muscle release: the TAR procedure. In: Novitsky YW (ed) Hernia surgery—current principles. Springer, Switzerland, pp 117–135

  13. 13.

    Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23:134–141

  14. 14.

    Favre A, Huberlant S, Carbonnel M et al (2016) Pedagogic approach in the surgical learning: the first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy. Front Surg 3:58

  15. 15.

    Majumder A, Fayezizadeh M, Neupane R et al (2016) Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg 222:1106–1115

  16. 16.

    Gonzalez A, Escobar E, Romero R et al (2017) Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc 31:1342–1349

  17. 17.

    Belyansky I, Weltz AS, Sibia US et al (2017) The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it? In Society of Gastrointestinal and Endoscopic Surgeons Surgical Spring Week 2017. Houston, Texas

  18. 18.

    Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89

  19. 19.

    Berger RL, Li LT, Hicks SC et al (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217:974–982

  20. 20.

    Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev (3):CD007781

Download references

Author information

Correspondence to Yuri W. Novitsky.

Ethics declarations

Disclosures

IB is a consultant for Intuitive Surgical Inc., Bard, Lifecell, Cook Surgical and Covidien. YWN is a consultant for Intuitive Surgical Inc., Bard and Cooper Surgical. Luis A. Martin-del-Campo and Adam S. Weltz has no conflict of interest or financial ties to disclose.

Additional information

Presented at the SAGES 2017 Annual Meeting, March 22-25, 2017, Houston, Texas.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Martin-del-Campo, L.A., Weltz, A.S., Belyansky, I. et al. Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32, 840–845 (2018). https://doi.org/10.1007/s00464-017-5752-1

Download citation

Keywords

  • Abdominal wall reconstruction
  • Robotic surgery
  • Transversus abdomins release (TAR)
  • Robotic hernia repair