Bauer K, Heinzelmann F, Büchler P, Mück B
Abteilung für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie, Klinikum Kempten, Klinikverbund Allgäu, Robert-Weixler-Str. 50, 87439, Kempten, Deutschland.
Chirurg. 2022 Jan;93(1):82-88. doi: 10.1007/s00104-021-01407-8. Epub 2021 Apr 19.
In recent years there has been a rise in robotic techniques and approaches regarding hernia repair with extraperitoneal mesh placement.
A retrospective analysis of the first 50 patients who underwent robotic ventral hernia repair between May 2019 and November 2020 at the department of general surgery of the Kempten Clinic was performed.
This case series consisted of 36 incisional hernias, 12 primary hernias (8 umbilical and 3 epigastric hernias in combination with a diastasis recti abdominis as well as 1 Spigelian hernia) and 2 parastomal hernias. A complete closure of the hernia was achieved in all cases. Extraperitoneal mesh placement in the retromuscular or preperitoneal space was achieved in 98 % of the ventral procedures. We used an extraperitoneal approach with retromuscular mesh implantation (r-eTEP= robotic enhanced view total extraperitoneal plasty) in 22 cases, 3 of those along with a transversus abdominis release (r-eTAR= robotic extraperitoneal transversus abdominis release) and 26 operations were carried out transperitoneally. These included 11 preperitoneal (r-vTAPP= robotic ventral TAPP), 7 retrorectus (TARUP= robotic transabdominal retromuscular umbilical prosthetic hernia repair) and 1 intraperitoneal onlay mesh placements (r-IPOM= robotic intraperitoneal onlay mesh) as well as 7 transperitoneal transversus abdominis releases with retromuscular mesh placement. The 2 parastomal hernias were treated with an intraperitoneal 3D funnel mesh. After the initial treatment of smaller hernias the indications could be rapidly extended to complex hernias in 38 % of this case series. One conversion to an open operation was necessary due to technical problems in closing the posterior rectus sheath. The complication rate was 12 % and the reintervention rate 4 %.
Robotic surgery of ventral hernia is safe and effective. Even complex hernias can be treated minimally invasively with closure of the hernia defect and extraperitoneal mesh placement.
近年来，采用腹膜外补片置入的机器人疝气修补技术和方法有所增加。
对2019年5月至2020年11月在肯普滕诊所普通外科接受机器人腹疝修补术的前50例患者进行回顾性分析。
该病例系列包括36例切口疝、12例原发性疝（8例脐疝、3例上腹疝合并腹直肌分离以及1例半月线疝）和2例造口旁疝。所有病例均实现了疝的完全闭合。98%的腹疝手术在肌后或腹膜前间隙进行了腹膜外补片置入。我们采用肌后补片植入的腹膜外方法（r-eTEP=机器人增强视野完全腹膜外修补术）进行了22例手术，其中3例同时进行了腹横肌松解（r-eTAR=机器人腹膜外腹横肌松解术），26例手术经腹腔进行。这些手术包括11例腹膜前手术（r-vTAPP=机器人腹侧经腹腹膜前修补术）、7例肌后手术（TARUP=机器人经腹肌后脐部人工疝修补术）和1例腹腔内补片置入手术（r-IPOM=机器人腹腔内补片置入术）以及7例经腹腔腹横肌松解并肌后补片置入手术。2例造口旁疝采用腹腔内3D漏斗补片治疗。在对较小疝进行初始治疗后，该病例系列中38%的患者适应证可迅速扩展至复杂疝。由于关闭腹直肌后鞘存在技术问题，有1例需要转为开放手术。并发症发生率为12%，再次干预率为4%。
机器人腹疝手术安全有效。即使是复杂疝也可通过微创方式实现疝缺损闭合和腹膜外补片置入。
