Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs
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Building on the principles of eTEP access, described by Dr. Jorge Daes, our group has previously described and standardized a novel minimally invasive approach to restoration of the linea alba and repair of lateral atypical defects of the abdominal wall. The purpose of this report is to present comparative analysis of laparoscopic and robotic eTEP access retrorectus repairs.
A retrospective review was conducted in patients who underwent laparoscopic eTEP (lap-eRS) and robotic-assisted eTEP (robo-eRS) Rives-Stoppa repairs between September 2015 and May 2018 at our institution. We analyzed the preoperative demographics and the perioperative outcomes.
Our review identified 206 patients (Lap-eRS 120 vs. robo-eRS 86). The groups were comparable (p > 0.05) in gender distribution (47.6% vs. 53% male) and mean age (53.2 vs. 50.8 years), but different (p < 0.05) in mean BMI (31.3 vs. 34.4 kg/m2) and ASA score (2.1 vs. 2.4). The robo-eRS group had a larger defect size (5.5 vs. 7.1 cm, p < 0.05), a longer mean operative time (120.4 vs. 174.7 min, p < 0.05), and a higher hospitalization cost ($5,091 vs. $6,751, p = 0.005) compared to the lap-eRS group. Average length of stay (0.2 vs. 0.1 days), length of drain placement (5.3 vs. 5.7 days), and reoperations (2.5% vs. 2.3%) were similar between lap-eRS and robo-eRS (p > 0.05). Patients in both groups (lap-eRS vs. robo-eRS) were followed for an average of 5.7 months vs. 5.5 months (p = .735) and showed similar recurrence rates (1.7% vs. 1.2%, p > 0.05).
We present the largest series to-date of eTEP access laparoscopic and robotic ventral hernia retrorectus repairs. Morbidly obese patients and those with more complex abdominal wall defects were more likely to undergo a robo-eRS. The significantly longer operative time and higher hospital cost associated with the robo-eRS group may be in part due to these factors. Both robotic and laparoscopic eTEP Rives-Stoppa repairs are associated with favorable perioperative outcomes and low recurrence rates.
KeywordseTEP Rives-Stoppa repair Ventral hernia repair Retromuscular repair Retrorectus repair Robo-eRS Lap-eRS
All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.
No financial support was received for this study.
Compliance with ethical standards
Dr. Belyansky has received honoraria for speaking engagements and consulting work from Intuitive, Bard Davol and Medtronic; he is an investor into IHC Inc. Dr. Lu, Dr. Addo, Dr. Ewart, Dr. Zahiri, Mr. Broda, Ms. Parlacoski have no conflicts of interest or financial ties to disclose.
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