V. Tam1, J. Borrebach2, S. Dunn2, J. Bellon2, H. Zeh1, M. E. Hogg1 1University Of Pittsburgh Medical Center,Division Of Surgical Oncology,Pittsburgh, PA, USA 2University Of Pittsburgh Medical Center,Wolff Center At UPMC,Pittsburgh, PA, USA
Introduction:
Over the past 5 years, robotic surgery has acquired an increasing share of general surgery cases. Robotic inguinal hernia repair has been shown to be safe and feasible by single surgeons in small case series, but no studies have assessed the safety and efficacy of robotic inguinal hernia repairs by multiple surgeons across multiple centers. We aimed to evaluate the outcomes of the early experience of over 200 consecutive robotic inguinal hernia repairs performed in an academic multi-hospital system.
Methods:
Consecutive robotic inguinal hernia repairs performed between 12/2015 and 3/2017 were analyzed. Retrospective chart review was performed to collect information pertaining to pre-operative patient characteristics and post-operative outcomes. Hospital records were queried for intra-operative information and readmission records. Descriptive statistics were performed to analyze the cohort.
Results:
Over 15 months, 210 robotic inguinal hernia repairs were performed across 7 hospitals by 16 surgeons. The mean patient age was 57.6 (SD 14.1) years, 91.9% were male, and the mean BMI was 26.8 (SD 4.4). Bilateral hernia repairs were performed on 72 (34.3%) patients. Incarceration was present in 13 (6.3%) patients, 29 (14.3%) had a reoperation for a recurrent hernia, and 46 (23.1%) had a history of any previous abdominal surgery. The mean operative time was 102.3 (SD 38.6) minutes and a resident or fellow trainee was present in the operating room for 87 (41.4%) cases. The only two intra-operative complications reported were a sigmoid serosal tear and one case of excessive blood loss. There were no conversions to open or reoperations. Follow-up was available for 145 (69.0%) patients at a mean length of 17.6 (SD 5.9) days. Minor post-operative complications occurred in 33 (15.7%) patients, including 10 (4.8%) with urinary retention and 9 (4.3%) with scrotal swelling. Of 11 (5.2%) patients who visited the emergency room visit for a procedure-related complication within 10 days after discharge, no patients required readmission.
Conclusion:
In the largest case series of robotic inguinal hernia repairs to date, early experience in an academic multi-hospital system with resident and fellow trainees produced safe outcomes including no open conversions, reoperations, or readmissions. Rates of minor complications were comparable to those reported for laparoscopic and open surgical approaches.