Enhancing the hole in patients with hernia: Does single-site surgery make any sense?
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LETTER TO THE EDITOR
Enhancing the hole in patients with hernia: Does single‑site surgery make any sense? H. R. Bosi1 · L. T. Cavazzola2 Received: 8 August 2020 / Accepted: 18 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Dear editor, We read with special interest the paper from Cuccurullo et al. [1] regarding single-site surgery for inguinal hernia repair. We all know about the current expansion of robotic surgery and the interest in even less invasive procedures. The use of a single access (or single port) for all instruments has been reported in the literature in the last decades in several procedures, and its technique for performing robotic inguinal herniorrhaphy has been described elsewhere [2]. However, in this paper [1], the authors describe a datum that draws attention and diverges from other studies: the absence of incisional hernias in the follow-up. The use of robotic platform added to laparoscopic techniques several benefits, such as a wider range of motion, image quality, and ergonomics for the surgeon. The use of single port in laparoscopic surgery is cumbersome, with loss of triangulation and collision between instruments, turning simple procedures in difficult scenarios even in experienced hands [2]. The robotic platform corrected the lack of triangulation and the collisions that laparoscopy could not avoid. However, the placement of the single-site trocar requires an incision of at least 2.5 cm in the aponeurosis, which represents at least twice the size of the incision required for the placement of the traditional laparoscopic trocar. There is already evidence in the literature that the formation of trocar hernias is directly related to the size of the device and the umbilical scar is the most frequent location [3, 4]. In studies using the single-port technique to perform cholecystectomy, the authors question whether the aesthetic benefit and the presence of only one site of pain would be worth the risk of incisional hernia formation [5].
* H. R. Bosi [email protected] 1
Universidade de Caxias do Sul, Rio Grande do Sul, Brazil
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
2
Given the above, performing a procedure that has a higher incidence of incisional hernia in a patient who is undergoing a herniorrhaphy from another location (and which has defined a collagen disease that increases the incidence of new defects) does not seem to be an advantageous option as the authors say. There is a lack of randomized studies comparing the two techniques to assess the real benefit of this procedure.
Compliance with ethical standards Conflict of interest The authors declare that they have no competing interests. Ethical approval Approval from the institutional review board was not required for this study. Human and animal rights This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent For this study formal consent is not required.
References 1. Cuccurullo D, Guerriero L,
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