Robotic-assisted pulley technique for the ventral hernia
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ORIGINAL ARTICLE
Robotic‑assisted pulley technique for the ventral hernia James J. Butz1 · Seth L. Newman1 Received: 13 May 2020 / Accepted: 17 October 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract When approaching complex abdominal wall hernias at either index operation or a subsequent reoperation for recurrent incarcerated abdominal wall hernias, a majority of surgeons consider mesh placement a key step in the prevention of a future recurrence. While the laparoscopic and open approaches show no significant difference in hernia recurrence, the laparoscopic approach to complex abdominal wall hernias does reduce surgical-site infection, postoperative ileus, improves short-term quality-of-life scores, and reduces hospital length of stay (Davies et al. in Am Surg 78(8):888–892, https: //www.ncbi.nlm.nih. gov/pmc/articles/PMC3500604/, 2012, McGreevy et al. in Surg Endosc 17(11):1778–1780, https://www.ncbi.nlm.nih.gov/ pubmed /129586 79, 2003, Bittner et al. in Surg Endosc 33:3069–3139, https: //doi.org/10.1007/s00464 -019-06907- 7, 2019). In this paper, we describe a robotic approach with a pulley technique to the fixation of polypropylene mesh in complex abdominal wall reconstruction. Our primary aim is to offer a new perspective to the re-creation of challenging abdominal walls and to encourage other surgeons to gain proficiency in the robotic approach. Additionally, the material cost to the technique is lower than that of self-expanding or deployable mesh reinforcements used in other laparoscopic approaches. Over time, as an institution breaks even on the cost of a robot with their return on investment, this technique offers potential cost-saving. Keywords Robotic · Hernia repair · Incarcerated abdominal wall hernias · Pulley technique Abbreviations T′ Tension prime To Tension knot F′ Force prime cm Centimeter mmHg Millimeters of mercury
Significance of this study The laparoscopic approach to abdominal wall hernias has been in existence for more than twenty years. The robotic pulley technique incorporates previously existing materials in a novel fashion to fix synthetic mesh to the abdominal wall for repair of ventral hernias. With the burgeoning prevalence of robotic assisted surgery, this technique provides a new method to the repair of the complex abdominal wall hernia with potential materials cost savings.
* James J. Butz [email protected] 1
Introduction Complex abdominal wall hernias may range from defects containing incarcerated omentum or viscera, to complete loss of domain. As these defects increase in size and age with worsening degrees of incarceration, they become more and more difficult to close primarily under suture repair. With the advent of the hernia mesh repair in the 1890s under Billroth, a framework was provided to adjoin tissue in a secure fashion without applying undue tension and reinforce repairs [4, 5]. Although, up until the 1950s, complications, such as infection and fracture, were routinely experienced with the mesh materials be
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