Surgical technology has ushered in a new paradigm shift that allows surgeons to offer patients hernia repair with improved accuracy and dexterity.
During robotic hernia surgery, your surgeon will sit at a console and view a 3D high-definition camera with a magnified view of the abdominal wall. They will then insert miniaturized instruments through tiny incisions. Keep reading the article below to learn more about Robotic Hernia Surgery.
Over the last decade, robotic hernia surgery has become increasingly popular compared to other surgical procedures, including laparoscopic and open techniques. Despite this, it is not well understood if robotic hernia repair has any advantage over other surgical methods. The surgeons at Syracuse Hernia Center have extensive experience with this new technology, and can discuss all your hernia repair options during a comprehensive consultation.
Robotic hernia repair is a minimally invasive surgical procedure that utilizes the da Vinci Surgical System, which allows for precise movements by the doctor with small instruments. This leads to smaller incisions, less pain and a faster recovery than traditional hernia repairs.
The robot-assisted hernia repair is performed through a series of small incisions in your abdomen (typically only three). After this procedure, you will have very few scars, which over time may not be noticeable.
For most hernias, a small piece of tissue is protruding through an abdominal wall defect. If left untreated, this hernia can increase in size over time and eventually lead to severe pain and bowel obstruction. The hernia is repaired by placing a mesh over the defect to reduce or eliminate future hernia formation.
This can be done in a number of ways, depending on the type and location of hernia. For example, the majority of hernias in the midline can be approached using lateral docking. However, for hernias in the groin or very cranial hernias, a suprapubic docking may be required.
In a recent study, researchers analyzed the outcomes of 75 Medicare-insured patients who underwent minimally invasive hernia repair using either the robotic or laparoscopic technique. The baseline patient demographics, medical comorbidities and hernia characteristics were similar in both groups. Although the robotic hernia repair group had a longer median operative time than the laparoscopic group, no major differences were observed between the two approaches. Postoperative NRS-11, quality-of-life scores and complication rates were also comparable between the groups. The results of this study are consistent with previous research demonstrating no significant benefit of robotic hernia repair over other surgical methods.
Advantages
A surgeon performs robotic hernia surgery through several small incisions less than an inch in length. He or she inserts a tube with a light and camera attached to it, called a laparoscope, through one of the incisions. The camera gives the surgeon a clear view of the hernia and surrounding tissue to allow for hernia repair. Next, the surgeon makes a series of smaller cuts to insert surgical tools to remove and repair the hernia. This process is very similar to traditional laparoscopic hernia repair, but offers several advantages.
The robot’s articulating arms allow the surgeon to maneuver with remarkable flexibility and precision. Unlike the straight, chopstick-like instruments used in laparoscopy, robotic instruments have 7 degrees of freedom and bend and rotate with incredible dexterity. This allows for precise placement of mesh and avoids trauma to delicate tissues. Similarly, the surgeon’s 3-D high-definition views magnified 10 times more than the human eye can see provide remarkable depth perception to allow for accurate hernia repair.
Patients also benefit from shorter hospital stays and quicker recovery times with robotic hernia surgery. The procedure requires minimal scarring and results in less pain, which enables patients to return to work and normal activities faster than traditional hernia repair.
In comparison, traditional open hernia repair involves a larger incision through the abdominal wall to directly access and repair the hernia site. The resulting complications, such as prolonged hospital stays and slower recovery periods, can make it difficult for hernia patients to return to their normal lives.
Although hernia recurrence rates are lower with robotic hernia surgery, long-term results (beyond 10 years) remain unknown. In addition, the procedure is more expensive than traditional hernia repair.
As with any surgery, the success of robotic hernia repair depends on a patient’s preparation and postoperative care. In particular, patients should be encouraged to follow their healthcare team’s instructions and stay hydrated. Additionally, patients should slowly increase their activity levels and follow dietary guidelines to support proper healing and prevent complications such as constipation. If patients smoke, it is important to stop smoking prior to surgery.
Risks
With minimally invasive robotic hernia surgery, patients can leave the hospital the same day and return to work and regular activities much faster than traditional open surgeries. This helps them recover sooner and can help reduce the risk of hernias recurring. However, the procedure is not without risks. Before undergoing this surgery, it’s important to understand the potential complications and discuss them with your doctor.
Surgical robots are becoming increasingly popular for hernia repair and other procedures due to their increased dexterity, 3-D vision, and articulating wrist technology. They allow surgeons to perform procedures in spaces that would be difficult to access with laparoscopy or conventional open surgery. In a recent study, general surgery resident Brian Fry, MD, and colleagues looked at the long-term outcomes of robotic hernia repairs in comparison to laparoscopic and open techniques.
They performed a retrospective analysis of 105 patients with an abdominal wall hernia who underwent either robotic or traditional laparoscopic hernia repair. They compared patient demographics, hernia characteristics, and operative times between the two groups. They also evaluated NRS-11 scores, postoperative patient-reported outcomes measured by PROMIS 3a, and hernia-specific quality of life scores before and 30 days after the operation.
The results were similar between groups. There were no significant differences in the number of complications or in hospital lengths of stay. The researchers observed two cases of full-thickness enterotomies but no unplanned reoperations or hernia recurrences. The median NRS-11 score in PACU and on postoperative days 0-1 and 7-30 was the same for both groups.
In their study, the hernia recurrence rate was significantly lower in patients who underwent robotic hernia repair than in those who had traditional hernia repairs (HR: 0.6% vs 0.9%; P0.001). They conclude that hernia recurrence rates in patients who underwent hernia repairs with low volumes of robotic surgery will eventually be comparable to rates in patients who underwent laparoscopic or open repairs.
Nevertheless, they stress that the current learning curve in hernia repair robotics is still relatively high. They recommend that surgeons who are new to robotics should aim to build a large volume of hernia repair cases and that credentialing bodies should require surgeons to accumulate sufficient experience before offering robotic hernia privileges.
Preparation
Before the surgery, you may need to undergo tests such as blood work or imaging to ensure you are healthy enough for the procedure. Your doctor will also examine you to determine if the hernia is the result of an underlying medical condition such as Crohn’s disease or inflammatory bowel syndrome.
During the robotic hernia surgery, your surgeon makes several small incisions into which a tiny camera and specialized instruments are inserted. Because it is minimally invasive, patients experience less pain and shorter recovery periods than those who undergo open hernia repair.
The robotic system uses advanced computer technology to allow your surgeon to view a high-definition 3D image of the surgical site. This magnified view allows your surgeon to see more detail than what the naked eye can perceive – it’s like having superhuman vision! It is a significant advantage in hernia repair because it can help your surgeon avoid damaging delicate structures.
In addition, the robot’s tools have 7 degrees of freedom to bend and move – they are very much like miniaturized hands working inside your body! These extraordinary capabilities make robotic hernia surgery more effective and safer than laparoscopic techniques. A previous study of hernia repairs using both laparoscopic and robotic techniques found that reduced early postoperative pain was comparable in matched groups.
After the surgery, you will be monitored in the hospital until you’re ready to return home. Most patients are able to return to their jobs and daily activities within a few days. However, you will need to rest and take it easy for several weeks. For example, you should avoid lifting anything that could put pressure on your abdomen.
A hernia that is not treated can increase in size and lead to complications such as the formation of a strangulated hernia, which is a life-threatening medical emergency. If your hernia is painful, feels swollen or protrudes, you should call us right away.
The best way to prevent hernias is to eat well and maintain a healthy weight. You should also wear loose clothing and avoid straining or bending over while lifting objects. If you develop a hernia, talk to your doctor about treatment options, such as surgical mesh.