Advertisement

Hernia Surgery pp 273-286 | Cite as

Robotic Ventral Hernia Repair

  • Conrad BallecerEmail author
  • Eduardo Parra-Davila
Chapter

Abstract

In this chapter we describe the repair of abdominal wall hernias utilizing the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA). This emerging technology has experienced an exponential growth in its adoption for the repair of both ventral and incisional hernias. This chapter offers a detailed description of the various approaches borrowing from the well-established techniques of both open and laparoscopic hernia repair. Approaches discussed include the placement of intraperitoneal onlay mesh (IPOM) after primary defect closure, preperitoneal placement of mesh, and retromuscular placement of mesh with posterior component separation utilizing the TAR technique. Perioperative details will also be discussed including but not limited to diagnostic evaluation, patient setup, and port position.

The technique of robot-assisted laparoscopic incisional hernia repair with intracorporeal closure of the fascial defect and continuous circumferential suturing for mesh fixation is feasible and may reduce postoperative pain by eliminating transfascial sutures. The component separation techniques done robotically may decrease the incidence of surgical site infection and occurrences in this difficult group of patients. Long-term data is lacking to truly assess the benefit to the patient and therefore further evaluations and studies are required.

Keywords

Robotic ventral hernia repair Robotar rTAPP ventral hernia repair Robotic incisional hernia repair 

Supplementary material

Video 26.1

Robotic TAPP inguinal repair, by Ballacer (MP4 1,736,375 kb)

Video 26.2

Robotic TAR, by Carbonell (MOV 918,251 kb)

References

  1. 1.
    Jin J, Rosen MJ. Laparoscopic versus open ventral hernia repair. Surg Clin North Am. 2008;88:1083–100.CrossRefPubMedGoogle Scholar
  2. 2.
    Novitsky YW, Elliott HL, Orenstein SB, et al. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204:709–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg. 2003;238:391–9.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Perrone JM, Soper NJ, Eagon JC, et al. Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery. 2005;138:708–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Carbajo MA, Martin de Olmo JC, Blanco JI, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999;13:250–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Franklin ME, Dorman JP, Glass JL, et al. Laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc. 1998;8:294–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Heniford BT, Ramshaw BJ. Laparoscopic ventral hernia repair: a report of 100 consecutive cases. Surg Endosc. 2000;14:419–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000;190:645–50.CrossRefPubMedGoogle Scholar
  9. 9.
    Sanders LM, Flint LM, Ferrara JJ. Initial experience with laparoscopic repair of incisional hernias. Am J Surg. 1999;177:227–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Ballantyne GH, Hourmont K, Wasielewski A. Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh. JSLS. 2003;7:7–14.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Earle D, Seymour N, Fellinger E, et al. Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc. 2006;20:71–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Harrell AG, Novitsky YW, Peindl RD, et al. Prospective evaluation of adhesion formation and shrinkage of intraabdominal prosthetics in a rabbit model. Am Surg. 2006;72:808–13.PubMedGoogle Scholar
  13. 13.
    McKinlay RD, Park A. Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg. 2004;8:670–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Heniford BT, Carbonell AM, Harold K, et al. Local Injection for the Treatment of Suture Site Pain after Laparoscopic Ventral Hernia Repair. Am Surg. 2003;69:688–91.PubMedGoogle Scholar
  15. 15.
    Lange JF, Halm JA, de Wall LL, et al. Intraperitoneal polypropylene mesh hernia repair complicates subsequent abdominal surgery. World J Surg. 2003;31(2):423–9.Google Scholar
  16. 16.
    Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring: review of early clinical results. Surg Endosc. 2002;16:1389–402.CrossRefPubMedGoogle Scholar
  17. 17.
    Ramirez OM, Ruas E, Dellon AL. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Rives J, Pire JC, Flament JB, et al. Treatment of large eventrations. New therapeutic Indications apropos of 322 cases. Chirurgie. 1985;111:215–25.PubMedGoogle Scholar

Further Reading

  1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg. 1985;72:70–1.CrossRefPubMedGoogle Scholar
  2. LeBlanc KA, Heniford BT, Voeller GR. Innovations in ventral hernia repair. Contemp Surg 2006:1–8Google Scholar
  3. Van der Linden FT, Van Vroonhoven TJ. Long-term results after surgical correction of incisional hernia. Neth J Surg. 1988;40:127–9.PubMedGoogle Scholar
  4. Stoppa RE. The treatment of complicated groin and incisional hernia. World J Surg. 1989;13:545–54.CrossRefPubMedGoogle Scholar
  5. Laber GE, Garb JL, Alexander AI, et al. Long-term complications associated with prosthetic repair of ventral hernias. Arch Surg. 1998;133:378–82.CrossRefGoogle Scholar
  6. White TJ, Santos MC, Thompson JS. Factors affecting wound complications in repair of ventral hernias. Am Surg. 1998;64:276–80.PubMedGoogle Scholar
  7. Berger D, Bientzle M, Muller A. Postoperative complications after laparoscopic incisional hernia repair. Surg Endosc. 2002;16:1720–3.CrossRefPubMedGoogle Scholar
  8. Bansal VK, Misra MC, Kumar S, et al. A prospective randomized study comparing suture mesh fixation versus tacker mesh fixation for laparoscopic repair of incisional and ventral hernias. Surg Endosc. 2011;25:1431–8.CrossRefPubMedGoogle Scholar
  9. Dubay DA, Wang X, Kirk S, et al. Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts. Wound Repair Regen. 2004;12:539–45.CrossRefPubMedGoogle Scholar
  10. Giulianotti PC, Coratti A, Angelini M, et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003;138:777–84.CrossRefPubMedGoogle Scholar
  11. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993;3:39–41.PubMedGoogle Scholar
  12. Schluender S, Conrad J, Divino CM, et al. Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing. Surg Endosc. 2003;17:1391–5.CrossRefPubMedGoogle Scholar
  13. Tayar C, Karoui M, Cherqui D, et al. Robot-assisted laparoscopic mesh repair of incisional hernias with exclusive intracorporeal suturing: a pilot study. Surg Endosc. 2007;21:1786–9.CrossRefPubMedGoogle Scholar
  14. LeBlanc KA. The critical technical aspects of laparoscopic repair of ventral and incisional hernias. Am Surg. 2001;67:809–12.PubMedGoogle Scholar
  15. Sorensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg. 2005;140:119–23.CrossRefPubMedGoogle Scholar
  16. Sauerland S, Walgenbach M, Habermalz B et al. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev. 2011; (3):CD007781.Google Scholar
  17. Forbes SS, Eskicioglu C, McLeod RS, et al. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg. 2009;96:851–8.CrossRefPubMedGoogle Scholar
  18. Sajid MS, Bokhari SA, Mallick AS, et al. Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg. 2009;197:64–72.CrossRefPubMedGoogle Scholar
  19. Beldi G, Wagner M, Bruegger LE, et al. Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc. 2011;25:749–55.CrossRefPubMedGoogle Scholar
  20. Allison N, Tieu K, Snyder B, Pigazzi A, Wilson E. Technical feasibility of a robotic assisted ventral hernia repair. World J Surg. 2012;36(2):447–52.CrossRefPubMedGoogle Scholar
  21. Bower CE, Reade CC, Kirby LW, Roth JS. Complications of laparoscopic incisional-ventral hernia repair: the experience of a single institution. Surg Endosc. 2004;18:672–5.CrossRefPubMedGoogle Scholar
  22. Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J. Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg. 2001;25:1467–77.PubMedGoogle Scholar
  23. Corcione F, Esposito C, Cuccurullo D, Settembre A, Miranda N, Amato F, Pirozzi F, Caiazzo P. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19:117–9.CrossRefPubMedGoogle Scholar
  24. Earle D, Seymour N, Fellinger E, Perez A. Laparoscopic versus open incisional hernia repair: a single-institution analysis of hospital resource utilization for 884 consecutive cases. Surg Endosc. 2006;20:71–5.CrossRefPubMedGoogle Scholar
  25. Heniford BT, Park A, Ramshaw BJ, Voeller G. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg. 2000;190:645–50.CrossRefPubMedGoogle Scholar
  26. LeBlanc KA. Current considerations in laparoscopic incisional and ventral herniorrhaphy. JSLS. 2000;4:131–9.PubMedPubMedCentralGoogle Scholar
  27. LeBlanc KA. The critical technical aspects of laparoscopic repair of ventral and incisional hernias. Am Surg. 2001;67:809–12.PubMedGoogle Scholar
  28. McKinlay RD, Park A. Laparoscopic ventral incisional hernia repair: a more effective alternative to conventional repair of recurrent incisional hernia. J Gastrointest Surg. 2004;8:670–4.CrossRefPubMedGoogle Scholar
  29. Park A, Birch DW, Lovrics P. Laparoscopic and open incisional hernia repair: a comparison study. Surgery. 1998;124:816–22.CrossRefPubMedGoogle Scholar
  30. Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, et al. Perioperative outcomes and complications of laparoscopic ventral hernia repair. Surgery. 2005;138:708–15.CrossRefPubMedGoogle Scholar
  31. Robbins SB, Pofahl WE, Gonzalez RP. Laparoscopic ventral hernia repair reduces wound complications. Am Surg. 2001;67:896–900.PubMedGoogle Scholar
  32. Rudmik LR, Schieman C, Dixon E, Debru E. Laparoscopic incisional hernia repair: a review of the literature. Hernia. 2006;10:110–9.CrossRefPubMedGoogle Scholar
  33. Talamini MA, Chapman S, Horgan S, Melvin WS. A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc. 2003;17:1521–4.CrossRefPubMedGoogle Scholar
  34. Tani KM, Neumayer L, Reda D, Kim L, Anthony T. Repair of ventral incisional hernia: the design of a randomized trial to compare open and laparoscopic surgical techniques. Am J Surg. 2004;188:22S–9.Google Scholar
  35. Van’t RM, Vrijland WW, Lange JF, Hop WC, Jeekel J, Bonjer HJ. Mesh repair of incisional hernia: comparison of laparoscopic and open repair. Eur J Surg. 2002;168:684–9.CrossRefPubMedGoogle Scholar
  36. Bageacu S, Blanc P, Breton C, Gonzales M, Porcheron J, Chamber M, Balique JG. Laparoscopic repair of incisional hernia: a retrospective review of 159 patients. Surg Endosc. 2002;16:345–8.CrossRefPubMedGoogle Scholar
  37. Bucknall TE, Cox PJ, Ellis H. Burst abdominal and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J. 1982;284:931–3.CrossRefGoogle Scholar
  38. Carbajo MA, de Olmo JC M, Blanco JI, de la Cuesta C, Toledano M, Martin F, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999;13:250–2.CrossRefPubMedGoogle Scholar
  39. Franklin ME, Dorman JP, Glass JL, Balli JE, Gonzalez JJ. Laparoscopic ventral and incisional hernia repair. Surg Laparosc Endosc. 1998;8:294–9.CrossRefPubMedGoogle Scholar
  40. Heniford BT, Ramshaw BJ. Laparoscopic ventral hernia repair: a report of 100 consecutive cases. Surg Endosc. 2000;14:419–23.CrossRefPubMedGoogle Scholar
  41. Hesselink VJ, Luijendijk RW, Heide R, Jeekel J. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet. 1993;176:228–34.PubMedGoogle Scholar
  42. Holzman MD, Purut CM, Reintgen K, Eubanks S, Pappas TN. Laparoscopic ventral and incisional hernia repair. Surg Endosc. 1997;11:32–5.CrossRefPubMedGoogle Scholar
  43. Kyzer S, Alis M, Aloni Y, Charuzi I. Laparoscopic repair of postoperation ventral hernia. Surg Endosc. 1999;13:928–31.CrossRefPubMedGoogle Scholar
  44. LeBlanc KA, Booth WV, Whitaker JM, Bellanger DE. Laparoscopic incisional and ventral herniorrhaphy: our initial 100 patients. Hernia. 2001;5:41–5.CrossRefPubMedGoogle Scholar
  45. Luxembourger O, Regairaz C. La cure des hernies et eventrations ombilicales et sous-ombilicales sous celioscopie: a propos de 22 cas. Lyon Chir. 1997;2:130–1.Google Scholar
  46. Ramshaw BJ, Esartic P, Schwab J, Mason EM, Wilson RA, Duncan TD, Miller J, Lucas GW, Promes J. Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg. 1999;65:827–31.PubMedGoogle Scholar
  47. Renier JF, Bokobza B, Leturgie C, Merveille M, Selamn M, Sfihi A. Cure des eventrations soud laparoscopie par plaque intraperitoneal d’ePTFE: technique et resultants, apropos de 135 cases. J Coeliochir. 1999;32:63–7.Google Scholar
  48. Sanders LM, Flint LM, Ferrara JJ. Initial experience with laparoscopic repair of incisional hernias. Am J Surg. 1999;177:227–31.CrossRefPubMedGoogle Scholar
  49. Thoman DS, Phillips EH. Current status of laparoscopic ventral hernia repair. Surg Endosc. 2002;16(932–942):1395.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Arrowhead Medical Center, Banner Thunderbird Medical CenterPeoriaUSA
  2. 2.General Surgery/ColorectalCelebrationUSA

Personalised recommendations