Belyansky I, Reza Zahiri H, Sanford Z, Weltz A S, Park A
Department of Surgery, Anne Arundel Medical Center, 2000 Medical Parkway, Suite 100, Annapolis, MD, 21401, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Hernia. 2018 Oct;22(5):837-847. doi: 10.1007/s10029-018-1795-z. Epub 2018 Jul 4.
The enhanced-view totally extraperitoneal (eTEP) hernia repair technique was first described for laparoscopic inguinal hernia repair and later applied to laparoscopic ventral and incisional hernia repair. We present our center's early operative outcomes utilizing principles of this technique during robotic ventral and incisional hernia repair for implementation of the robotic eTEP Rives-Stoppa (eRS) and eTEP transversus abdominis release (eTAR) techniques.
A review of a prospectively maintained database of hernia patients was conducted identifying 37 patients who underwent robotic eTEP for ventral, incisional, flank or parastomal hernia repair between March and October 2017. All patients underwent retrorectus dissection with selective utilization of transversus abdominis release (TAR) as indicated.
37 patients including 13 male and 24 female with mean age, body mass index, and ASA score of 54, 35.5, and 2.4, respectively, underwent a mean operation room time of 198 min. Mean length of stay was 0.7 days. There were no intraoperative complications. Two patients developed subcutaneous seromas requiring interventional radiology drainage. One patient was readmitted at 30 days for PO intolerance that was managed expectantly. Mean postoperative follow-up visit occurred at 36 days with no sign of early hernia recurrences.
The enhanced-view totally extraperitoneal approach is both safe and feasible in robotic-assisted repair of ventral and incisional hernias. Although long-term outcomes and patient selection criteria require further study, we believe this technique will become an important tool in the armamentarium of minimally invasive hernia surgeons.
增强视野完全腹膜外（eTEP）疝修补技术最初用于腹腔镜腹股沟疝修补，后来应用于腹腔镜腹侧和切口疝修补。我们展示了我们中心在机器人辅助腹侧和切口疝修补术中运用该技术原理实施机器人eTEP里夫斯 - 斯托帕（eRS）和eTEP腹横肌松解（eTAR）技术的早期手术结果。
回顾前瞻性维护的疝患者数据库，确定2017年3月至10月间37例行机器人eTEP腹侧、切口、侧腹或造口旁疝修补术的患者。所有患者均行直肠后间隙分离，并根据需要选择性地运用腹横肌松解（TAR）。
37例患者，包括13例男性和24例女性，平均年龄、体重指数和美国麻醉医师协会（ASA）评分分别为54岁、35.5和2.4，平均手术时间为198分钟。平均住院时间为0.7天。无术中并发症。2例患者出现皮下血清肿，需要介入放射学引流。1例患者在30天时因口服不耐受再次入院，保守治疗。术后平均随访时间为36天，无早期疝复发迹象。
增强视野完全腹膜外入路在机器人辅助腹侧和切口疝修补术中安全可行。尽管长期结果和患者选择标准需要进一步研究，但我们相信该技术将成为微创疝外科医生的重要工具。
