Top

Surgical Endoscopy

Published in:

01-02-2018

Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release

Authors: Luis A. Martin-del-Campo, Adam S. Weltz, Igor Belyansky, Yuri W. Novitsky

Published in: Surgical Endoscopy | Issue 2/2018

Abstract

Background

Transversus abdominis release (TAR) has evolved as an effective approach to complex abdominal wall reconstructions. Although the role of robotics in hernia surgery is rapidly expanding, the benefits of a robotic approach for abdominal wall reconstruction have not been established well. We aimed to compare the impact of the application of robotics to the TAR procedure on the perioperative outcomes when compared to the open TAR repairs.

Methods

Case-matched comparison of patients undergoing robotic TAR (R-TAR) at two specialized hernia centers to a matched historic cohort of open TAR (O-TAR) patients was performed. Outcome measures included patient demographics, operative details, postoperative complications, and length of hospitalization.

Results

38 consecutive patients undergoing R-TAR were compared to 76 matched O-TAR. Patient demographics were similar between the groups, but ASA III status was more prevalent in the O-TAR group. The average operative time was significantly longer in the R-TAR group (299 ± 95 vs.. 211 ± 63 min, p < 0.001) and blood loss was significantly lower for the R-TAR group (49 ± 60 vs. 139 ± 149 mL, p < 0.001). Wound morbidity was minimal in the R-TAR, but the rate of surgical site events and surgical site infection was not different between groups. Systemic complications were significantly less frequent in the R-TAR group (0 vs. 17.1%, p = 0.026). The length of hospitalization was significantly reduced in the R-TAR group (1.3 ± 1.3 vs. 6.0 ± 3.4 days, p < 0.001).

Conclusions

In our early experience, robotic TAR was associated with longer operative times. However, we found that the use of robotics was associated with decreased intraoperative blood loss, fewer systemic complications, shorter hospitalizations, and eliminated readmissions. While long-term outcomes and patient selection criteria for robotic TAR repair are under investigations, we advocate selective use of robotics for TAR reconstructions in patients undergoing AWR.

Fitzgerald HL, Orenstein S, Poi MJ, Novitsky YW (2009) Transversus abdominis muscle release: a novel approach to posterior fascia release during retromuscular abdominal wall reconstructions. Abstracts of the 4th Joint Hernia Meeting of the American Hernia Society and European Hernia Society. September 9–12, 2009. Berlin, Germany. Hernia 2009; 13:104

Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716CrossRefPubMed

Petro CC, Como JJ, Yee S et al (2015) Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen. J Trauma Acute Care Surg 78:422–429CrossRefPubMed

Novitsky YW, Fayezizadeh M, Majumder A et al (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232CrossRefPubMed

Petro CC, Orenstein SB, Criss CN et al (2015) Transversus abdominis muscle release for repair of complex incisional hernias in kidney transplant recipients. Am J Surg 210:334–339CrossRefPubMed

Fayezizadeh M, Majumder A, Belyansky I, Novitsky YW (2016) Outcomes of retromuscular porcine biologic mesh repairs using transversus abdominis release reconstruction. J Am Coll Surg 223:461–468CrossRefPubMed

Wang J, Majumder A, Fayezizadeh M et al (2016) Outcomes of retromuscular approach for abdominal wall reconstruction in patients with inflammatory bowel disease. Am Surg 82:565–570PubMed

Winder JS, Behar BJ, Juza RM et al (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223:271–278CrossRefPubMed

Ballecer C, Parra-Davila E (2016) Robotic ventral hernia repair. In: Novitsky YW (ed) Hernia surgery—current principles. Springer, Switzerland, pp 273–286

10.

Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31:324–332CrossRefPubMed

11.

Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278CrossRefPubMed

12.

Novitsky YW (2016) Posterior component separation via transversus abdominis muscle release: the TAR procedure. In: Novitsky YW (ed) Hernia surgery—current principles. Springer, Switzerland, pp 117–135

13.

Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23:134–141CrossRefPubMed

14.

Favre A, Huberlant S, Carbonnel M et al (2016) Pedagogic approach in the surgical learning: the first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy. Front Surg 3:58CrossRefPubMedPubMedCentral

15.

Majumder A, Fayezizadeh M, Neupane R et al (2016) Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg 222:1106–1115CrossRefPubMed

16.

Gonzalez A, Escobar E, Romero R et al (2017) Robotic-assisted ventral hernia repair: a multicenter evaluation of clinical outcomes. Surg Endosc 31:1342–1349CrossRefPubMed

17.

Belyansky I, Weltz AS, Sibia US et al (2017) The trend toward minimally invasive complex abdominal wall reconstruction: is it worth it? In Society of Gastrointestinal and Endoscopic Surgeons Surgical Spring Week 2017. Houston, Texas

18.

Liang MK, Holihan JL, Itani K et al (2017) Ventral hernia management: expert consensus guided by systematic review. Ann Surg 265:80–89CrossRefPubMed

19.

Berger RL, Li LT, Hicks SC et al (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217:974–982CrossRefPubMed

20.

Sauerland S, Walgenbach M, Habermalz B et al (2011) Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev (3):CD007781

Title: Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release
Authors: Luis A. Martin-del-Campo
Adam S. Weltz
Igor Belyansky
Yuri W. Novitsky
Publication date: 01-02-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5752-1

At a glance: The STEP trials

Springer Medicine

Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Laparoscopic left hepatectomy for mucinous cystic neoplasm of the liver

Impact of laparoscopy on the prevention of pulmonary complications after thoracoscopic esophagectomy using data from JCOG0502: a prospective multicenter study

Increased glycine-amidated hyocholic acid correlates to improved early weight loss after sleeve gastrectomy

Safety and feasibility of the robotic platform in the management of surgical sequelae of chronic pancreatitis

Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae

Stent migration following endoscopic suture fixation of esophageal self-expandable metal stents: a systematic review and meta-analysis