NYU Langone Health, Department of Urology, New York, NY.
NYU Langone Health, Department of Urology, New York, NY.
Urology. 2021 Dec;158:232-236. doi: 10.1016/j.urology.2021.08.030. Epub 2021 Sep 3.
To describe a novel method of robotic assisted laparoscopic parastomal hernia repair (RAL-PHR), including the evolving use of the Da Vinci Single Port (SP) robotic system.
Demographic, intraoperative, and postoperative variables were collected for patients who underwent RAL-PHR. The technique for RAL-PHR utilizes a 3 cm incision in the contralateral upper quadrant for the robotic trocar and a 12 mm assistant port. The hernia sac is freed from the fascial defect. Dual Surface Mesh is approximated to the fascial edges with a portion excised to tailor the conduit.
Four patients underwent RAL-PHR and three utilized the SP robot. Median age was 74.4 (range: 69.0-76.9) and median BMI 28.6 (26.5-43.2). All patients underwent cystectomy for bladder cancer and median time from index operation to parastomal hernia repair was 47.3 (40.4-11.48) months. Concurrent operations to hernia repair included ureteroenteric stricture repair, panniculectomy, abdominal wall reconstruction, stoma revision, and incisional hernia repair. Median operative time was 3.9 (2.6-8.7) hours including concurrent operations, median EBL was 50 (10-100) cc, mesh used in 3 cases, with no intraoperative complications reported. Median length of stay was 1 day and 1 post-operative complication greater than Clavien 2 reported. At median follow up of 18.3 (3.63-38.3) months, no recurrences were reported and 1 patient had undergone stoma dilation in the OR.
RAL-PHR using the SP system maximizes advantages of laparoscopic repair while allowing for flexibility to perform concurrent procedures and safer takedown of adhesions through just two incisions. RAL-PHR is a safe and effective alternative to open and laparoscopic parastomal hernia repair with several additional benefits.
描述一种新的机器人辅助腹腔镜旁疝修补术（RAL-PHR）方法，包括对达芬奇单端口（SP）机器人系统的不断使用。
收集接受 RAL-PHR 的患者的人口统计学、术中及术后变量。RAL-PHR 的技术利用对侧上象限的 3cm 切口进行机器人套管，并使用 12mm 辅助端口。游离疝囊从筋膜缺损中释放出来。双表面网片与筋膜边缘接近，一部分被切除以裁剪管道。
四名患者接受了 RAL-PHR，其中三名患者使用了 SP 机器人。中位年龄为 74.4 岁（范围：69.0-76.9），中位 BMI 为 28.6（26.5-43.2）。所有患者均因膀胱癌而行膀胱切除术，从初次手术到旁疝修补的中位时间为 47.3 个月（40.4-11.48）。同时进行的手术包括输尿管肠吻合口狭窄修复、腹带切除术、腹壁重建、造口修复和切口疝修复。包括同时进行的手术在内，中位手术时间为 3.9 小时（2.6-8.7），中位 EBL 为 50（10-100）cc，3 例使用网片，无术中并发症报告。中位住院时间为 1 天，1 例术后并发症大于 Clavien 2 级。中位随访 18.3 个月（3.63-38.3），无复发报告，1 例患者在手术室进行了造口扩张。
RAL-PHR 使用 SP 系统最大限度地发挥了腹腔镜修复的优势，同时允许通过仅两个切口灵活地进行同时进行的手术，并更安全地拆除粘连。RAL-PHR 是一种安全有效的替代开放和腹腔镜旁疝修补术的方法，具有几个额外的优势。
