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Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Vivekanand Sharma¹, Hesham Elkhwalka², Estelle Martin³

¹Department of Surgery, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK. drvivekanandsharma@gmail.com.

Journal of Robotic Surgery

|October 23, 2024

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This summary is machine-generated.

Robotic assisted surgery significantly reduced incisional hernias after right hemicolectomy compared to laparoscopy. While robotic surgery eliminated midline hernias, port site hernias require attention.

Area of Science:

Colorectal Surgery
Minimally Invasive Surgery
Surgical Oncology

Background:

Traditional laparoscopic right hemicolectomy often involves a midline incision for specimen extraction, leading to a high incidence of incisional hernias (up to 20%).
Robotic assisted surgery (RAS) facilitates intracorporeal anastomosis, potentially avoiding midline extraction and reducing hernia rates, though its superiority over laparoscopy is debated.

Purpose of the Study:

To compare the rate of radiologically detected incisional hernias between robotic assisted surgery with Pfannenstiel extraction and standard laparoscopy with extracorporeal anastomosis.
To evaluate the incidence of port site hernias in 8mm robotic ports, where routine closure is not always performed.

Main Methods:

A single-center retrospective cohort study included 100 patients (50 robotic, 50 laparoscopic) who underwent minimally invasive right hemicolectomy.

Keywords:

Incisional hernia Laparoscopic surgery Minimally invasive colorectal surgery Right hemicolectomy Robotic surgery Surgical outcomes

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Patients had cross-sectional imaging at least one year post-surgery to assess for new extraction site or port site hernias.

Data collected included patient demographics, BMI, smoking history, previous surgery, and hernia characteristics.

Main Results:

No midline extraction site hernias were observed in the robotic assisted surgery group, compared to 16% (8 patients) in the laparoscopic surgery group.
Three patients developed hernias at the site of 8mm robotic ports, predominantly at the right iliac fossa port.

Conclusions:

Robotic assisted surgery, especially with Pfannenstiel extraction, can potentially eliminate midline incisional hernias following right hemicolectomy.
The risk of clinically significant hernias at 8mm robotic port sites warrants consideration, emphasizing the need for meticulous port site closure to prevent patient harm.