Robotic-assisted single site (RASS) TAPP: an advantageous choice?
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ORIGINAL ARTICLE
Robotic‑assisted single site (RASS) TAPP: an advantageous choice? Outcomes of single site robotic groin hernia repair D. Cuccurullo1 · L. Guerriero1 · P. Favoriti1 · G. Mazzoni1 · C. Sagnelli1 · E. Tartaglia1 Received: 17 May 2020 / Accepted: 20 July 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Laparoscopic transabdominal preperitoneal (TAPP) is a valid option for bilateral primary groin hernia and recurrent cases. Robotic approach for inguinal hernia is still debated. The aim of this study is to investigate the potential role of robotic-assisted single site-TAPP (RASS-TAPP) reporting our experience. Methods We performed 44 RASS TAPP in 32 patients from February 2016 to July 2018. Data on patient demographics, type of hernia, operative time, complications, recurrence rate and hospital stay were retrospectively analyzed. Follow-up was scheduled at 1 week, 4 months and 1 year after surgery. Results Forty-two hernias were treated in 32 patients (27 M). Mean age was 48.6 years (range 20–67), mean BMI was 26.49 kg/m2 (range 16–34.9). Mean operative time was 54.8 min (range 28–150). In two cases (6%) a conversion to laparoscopy was necessary. At 1 week, two scrotal hematomas and four seromas were observed and treated conservatively. At 4 months follow-up, one patient (3.1%) complained temporary pain. No patient had inguinal recurrence or incisional umbilical hernia and chronic pain at 1-year follow-up. Conclusion RASS TAPP is feasible and safe with a high patient satisfaction. However, the surgeon experiences a technical discomfort due to the conflict of the instrumentation which influences negatively the choice of this approach, despite the better vision and augmented dexterity provided by the robot. Keywords Inguinal hernia repair · TAPP · Robotic trans-abdominal preperitoneal (rTAPP) · Robotic single port acces · RASS TAPP · Concurrent inguinal hernia repair
Introduction Operative techniques have continuously evolved over the past decades to provide the best management for inguinal hernias. Open approach is considered the gold standard for non-complicated primary inguinal hernia repair. After the introduction of laparoscopy, new techniques such as the transabdominal preperitoneal (TAPP) repair and the totally extraperitoneal repair (TEP) gained progressive acceptance with promising results and comparable outcomes to the open approach. Multiport robotic TAPP (rTAPP) is the natural evolution of hernia repair using the same operative * E. Tartaglia [email protected] 1
Department of Laparoscopic and Robotic General Surgery, Azienda Ospedaliera Dei Colli “Monaldi Hospital”, 80131 Naples, Italy
principles but with critical advance that change both the patient and surgeon’s experience [1]. In 2014, the first series of robotically assisted single-site (RASS) transabdominal preperitoneal TAPP inguinal hernia repair were described, showing the safety and effectiveness of the procedure and its benefits such as three-dimensional vison and augmented dexte
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