INTRODUCING ROBOTIC ABDOMINAL WALL SURGERY IN A GERMAN HERNIA CENTER – ONE YEAR EXPERIENCE

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Abstract Background Robotic surgery is the latest innovation in abdominal wall surgery. After implementing robotic surgery at our hernia center, we want to analyze our experience and present the perioperative data. Method We present our 1-year experience of robotic abdominal wall surgery regarding the type of operations and perioperative data. Results Between January 2023 and December 2023, we performed 59 robotic hernia operations. Consecutively, 20 inguinal hernias and 4 umbilical/epigastric hernias were repaired with preperitoneal mesh placement (TAPP-technique). Altogether 28 incisional hernias were treated either with preperitoneal or retromuscular mesh placement. Furthermore, seven parastomal hernia repairs (Pauli procedure) were performed. Additionally, one Morgagni Hernia was repaired with preperitoneal Mesh placement. Altogether, in 25 cases transversus abdominis release (TAR) was necessary for tension free closure of the defect and sufficient mesh overlap. In the postoperative course, there were three minor complications (haematoma, wound infection, intestinal paralysis). One patient underwent diagnostic laparoscopy to rule out any bowel injury. Another patient underwent laparotomy for repair of a small bowel injury after extensive adhesiolysis. Even though anticoagulated one patient developed severe pulmonary embolism. The mean hospital stay was 2,6 days (range: 1–9). Conclusion The implementation of robotic abdominal wall surgery in a hernia center with well-founded experience is safe and shows promising results. Regarding operative trauma and postoperative outcome, preperitoneal approaches for primary ventral hernia as compared with conventional methods seems a promising alternative due to the limited dissection. Patient selection and cost effectiveness as well as long term outcomes needs further investigation.

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