Surgeons have successfully repaired 39 complex lateral abdominal wall hernias using robotic surgery, allowing most patients to leave the hospital after just one day, according to a new Israeli study published in the journal Hernia.
A hernia occurs when tissue or part of an organ pushes through a weak spot in the abdominal wall. Lateral abdominal wall hernias form along the side of the body rather than in the groin or the middle of the abdomen, making them especially challenging to treat.
Repairing these hernias is difficult because they sit close to the ribs, pelvis, muscles, nerves and blood vessels, leaving surgeons little room to operate or to position the mesh used to reinforce the abdominal wall. Earlier operations can make matters worse by leaving scar tissue and altering the patient's standard anatomy.
The study was led by Dr. Michael Freund of the Hebrew University and Shaare Zedek Medical Center, under the guidance of Prof. David Hazzan of Raphael Hospital, in collaboration with Sheba Medical Center and Tel Aviv University. Most of the patients had developed their hernias at the site of a previous operation, including kidney, colorectal, spinal or gallbladder surgery.
Without robotic assistance, such patients would typically face either open surgery, which requires a large incision and a longer recovery, or conventional keyhole surgery. While keyhole procedures use smaller incisions, they rely on rigid instruments that are hard to maneuver at the angles required to repair a hernia on the side of the body.
Robotic instruments, by contrast, can bend and rotate like a human wrist and give surgeons a magnified, three-dimensional view of the operating area. This makes it substantially easier to reach the hernia, close the opening and place a large piece of reinforcing mesh behind the muscle.
The results compare favorably with another recent study of hernias located away from the center of the abdomen, in which some procedures had to be partly converted to open surgery, complications occurred in around one-third of patients and some hernias returned. In the Israeli study, every operation was completed robotically and no hernias returned during the follow-up period. The researchers stressed, however, that the two studies involved different patients and cannot be directly compared.
Two patients did develop bowel obstructions and required an additional laparoscopic procedure, but both recovered without needing any part of the bowel removed. Most patients recovered without complications and reported little pain after surgery.
The researchers noted that while this was one of the largest studies focused specifically on robotic repair of lateral abdominal wall hernias, it remained a relatively small retrospective study and did not directly compare robotic surgery with other methods. They said patients will need to be followed for longer to establish the long-term success rate.
