Abdominal wall reconstruction: new technology for new techniques

Robotics can overcome some obstacles of conventional laparoscopy and even highly complex procedures become feasible using a minimally invasive approach. Repair of complex ventral hernia using a myofascial flap and mesh augmentation, a technique called transversus abdominis release (TAR), for ventral abdominal hernia repair is one example. Herein, we present our institutional experience with this novel technique.

Patients undergoing robot-assisted TAR for repair of complex ventral hernia between September 2017 and October 2020 were included. Demographic as well as peri- and postoperative details were collected in a prospective database.

A total of 48 (17 female) patients were operated using robot-assisted TAR during the study period. Median BMI was 29 kg/m² (range: 22.0–40.5), age at operation was 69 years (median; range: 39–79). Duration of the procedure was 242 min (median), length of postoperative hospital stay was 4 days. One on-table complication was observed: during extubation, an audible tear of suture material was heard by OR staff. The patient had to be re-intubated and closure of the ventral defect was now done using an open access. Prolonged respiratory support was necessary in this patient. Urosepsis occurred in one patient following TAR combined with TURB (transurethral resection of bladder cancer), which was treated with intravenous antibiotics. In addition, one patient was re-admitted at 5 weeks postoperatively, suffering from small bowel obstruction which was solved using a minimally invasive approach. Late complications included three seromas (n = 3; 6.3%), one recurrent hernia (2.1%), and one trocar site hernia (2.1%). None of the latter patients needed an operative revision. No patient died.

Robot-assisted TAR for complex ventral hernia repair is a viable option in our setting with low complication and recurrence rates.