Abstract


Background: Robotic-assisted surgery has proved to be a valuable modality in specialties such as urology and gynecology and has gained wide acceptance in those fields. Its value in general surgery, however, has had a slower acceptance rate among surgeons. This study reviews my first 150 cases using the robot for one of the most common general surgery operations—the repair of hernias.
Materials and Methods: All robotic hernia cases performed by a single surgeon were documented in an Excel® (Microsoft Corporation, Redmond, Washington) spreadsheet beginning in April, 2014. Data recorded included patient diagnosis, hernia defect size, mesh type and size, console time and total operative time, as well as first assistant (fellow, resident, or none). The postoperative course was carefully reviewed through the electronic medical record to identify complications and readmissions.
Results: The average total case time was 138 minutes, while the average console time was 100 minutes. Incisional hernias made up 50.4% of the procedures, inguinal hernias—17.2%, ventral/umbilical—9.8%, parastomal—9.2%, lumbar—5.5%, hiatal—4.9%, and spigelian—2.5%. The average defect size was 48.47cm2. Complication rates were low at 5.3%, most of which were minor. There were no mortalities. There has been one known hernia recurrence.
Conclusions: This review shows that the use of the robot has proven to be safe and effective, and it has many benefits in hernia repair. One of those benefits is the ability to close the fascial defect with a running suture, thus avoiding the postoperative pain associated with transfascial sutures. The ability to intracorporeally fix a large piece of mesh to the abdominal wall that adequately and evenly covers the defect is another benefit. The high-quality three-dimensional view and the ability to articulate the instruments are well-established benefits of the robot as well. Robotic assistance also allows us to perform a minimally invasive hernia repair on large complex defects that would have otherwise been performed via an open approach.

Abstract


A common post-operative complication of many operations is seroma formation, which, while generally considered to be relatively minor, can be problematic for patients and a drain on healthcare resources due to the need for frequent outpatient reviews and repeated aspirations. Several mechanisms have been implicated in the development of seromas, and drains have traditionally been used as a preventative strategy. However, drains are falling out of favour, not least because the evidence to support their use is limited and conflicting. In recent years, the use of quilting sutures, also known as progressive tension sutures, is starting to emerge as a favourable alternative for preventing post-operative seroma formation. Several studies and trials support their use in abdominal wall operations such as abdominoplasties and at abdominal wall donor sites in reconstructive breast operations. General surgeons perform many operations on the abdominal wall, such as ventral hernia repair, that predispose the patient to seroma formation. Can quilting sutures be used in operations on the abdominal wall to prevent seroma formation? This aim of this review was to evaluate the use of quilting sutures as described in several studies to reduce the incidence of post-operative seroma.