72 - Freie Mitteilung
Bariatry & hernia I
16. Mai 2019, 17:30 - 19:00, Bellavista 3+4, 6. OG
Robotic-assisted laparoscopic groin hernia repair (R-TAPP) - An upcoming technique - A single center trial comparing laparoscopic (L-TAPP) versus robotor-assisted (R-TAPP) procedure in two affiliates of a cantonal hospital
S. H. Lamm, I. Rosenblum, D. Eucker, R. Rosenberg, B. Schenkluhn, Presenter: S. H. Lamm (Liestal)
Muysoms et al. has previously shown that R-TAPP (transabdominal preperitoneal procedure) with an DaVinci XI system is feasible and comparable to the laparoscopic TAPP even in an outpatient setting. In our hospital we changed our peritoneal closure regime based on international recommendations and perform a peritoneal closure with a V-locR running suture. The DaVinci program was relaunched in November 2018. One selected technique was the R-TAPP. External training was performed previously at Maria midellares hospital.
A DaVinci Si robotic system was used to perform R- TAPP in standard laparoscopic technique without fixation of the mesh( 10x15 cm). Patients undergoing R-TAPP were prospectively entered into the multicenter internet-based Herniamed Hernia Registry (Nov. 2018-April 2019)
Preliminary results of this ongoing study are described here. Up to present we have performed ten R-TAPP in seven patients. Three of seven patients had bilateral medial hernias. In three patients we found them combined with femoral hernias and in one case with an additional obturator hernia. One patient had a medial recurrence after open Lichtenstein procedure. Docking time (Skin-to-end of docking) decreased from 62 minutes in patient number one to 24 minutes in patient number seven. Mean skin-to-skin operating time over 103 single site L-TAPP performed at our affiliate Bruderholz was 62 minutes (Herniamed database 01.01.2017-31.12.2018). Mean operating time in 4 single site R-TAPP was 89 +/- 5 min and 3 bilateral TAPP was 196 +/- 50min. No complications related to the introduction of robotic-assisted laparoscopic groin hernia repair were observed perioperatively up to now. All patients are seen in our outpatient department 4-6 weeks after surgery.
Both the docking procedure and the operation have been optimized after only ten R-TAPP . Possible advantages include perfect visualization, movement of the instruments compared to a laparoscopic procedure and in consequence a faster running suture for the closure of the peritoneum. The procedure seems to be safe and feasible even for outpatient surgery. The cost of the procedure seems to be comparable to laparoscopic procedures if single use instruments are used in both procedures. We think that robotic surgery is an upcoming trend. We identified the R- TAPP as the perfect procedure to start with robotic surgery.