Multisite hernia treatment: the robotic approach makes it feasible.

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Hernia Repair

Background:

• Combined abdominal wall hernias, including multiquadrant hernias, present a frequent clinical challenge.
• The literature on robotic surgery for these complex cases remains limited.
• Simultaneous hernias, while not well-documented in prevalence, are common in surgical practice.

Purpose of the Study:

• To evaluate the feasibility and outcomes of a robotic approach for treating simultaneous epigastric, umbilical, incisional, and inguinal hernias.
• To compare outcomes between single and double docking robotic techniques for combined hernia repair.

Main Methods:

• Retrospective review of a prospectively maintained dataset of abdominal wall hernia patients.
• Identification of patients treated for combined hernias (midline and inguinal).
• Analysis of data based on robotic docking technique (single vs. double docking).

Main Results:

• Thirty patients underwent robotic combined hernia repair between January 2020 and December 2024.
• Single docking was feasible for midline defects (median diameter 2.0 cm) with unilateral inguinal hernias (9 patients).
• Double docking was required for wider midline defects (median diameter 3.0 cm) or bilateral inguinal hernias (70% of patients).
• No intraoperative complications or conversions were reported.
• Median operative times were 158 minutes (single docking) and 238 minutes (double docking).
• Median hospital stays were 2 days (single docking) and 3 days (double docking).
• Morbidity rates were 11.1% (single docking) and 23.8% (double docking), with most complications being seromas or hematomas.
• No recurrences were observed at a median follow-up of 15.6 months.

Conclusions:

• Robotic combined hernia repair is a safe and effective minimally invasive option.
• Single docking is advantageous for midline defects with unilateral inguinal hernias.
• Double docking is generally necessary for wider midline defects or bilateral inguinal hernias, offering a viable solution for complex cases.