Department of Surgery, Montefiore Medical Center, 182 East 210th street BSMT, Bronx, NY, 10467, USA.
Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.
Surg Endosc. 2022 Jul;36(7):4862-4868. doi: 10.1007/s00464-021-08835-x. Epub 2021 Nov 1.
Post-herniorrhaphy pain is common with an estimated 8-10% incidence of mesh-related complications, requiring mesh explantation in up to 6% of cases, most commonly after inguinal hernia repairs. Reoperation for mesh explantation poses a surgical challenge due to adhesions, scarring and mesh incorporation to the surrounding tissues. Robotic technology provides a versatile platform for enhanced exposure to tackle these complex cases. We aim to share our experience with a novel robotic approach to address these complex cases.
A descriptive, retrospective analysis of patients undergoing a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia by two surgeons between the period of March 2016 and January of 2020. The patients were evaluated for resolution of mesh related abdominal pain as well as early post-operative complications. RoME was performed with concomitant hernia repair in cases of recurrences.
Twenty-nine patients underwent a robotic mesh explantation (RoME) for mesh-related chronic pain, or recurrent ventral hernia between March 2016 and January of 2020. Nineteen patients (65.5%) had a prior inguinal hernia repair and 10 patients (34.5%) had a prior ventral hernia repair. Indications for mesh removal included chronic pain with or without hernia recurrence. Seventeen patients (58.6%) reported improvement or resolution of pain postoperatively (63% with a prior inguinal hernia repair and 50% of patients with a prior ventral hernia repair). Five patients (17.2%) required mesh reinforcement after explantation. Nineteen patients (65.5%) underwent mesh explantation with primary fascial closure or no mesh reinforcement. The mean follow-up was 36.4 days. The most common postoperative complication was seroma formation (6.8%), with one reported recurrence (3.4%).
Robotic mesh explantation in challenging cases due to the effect of chronic scarring, adhesions and mesh incorporation to the surrounding tissues is safe and provides an advantageous platform for concomitant hernia repair in these complex cases.
疝修补术后疼痛很常见，估计有 8-10%的病例会出现网片相关并发症，多达 6%的病例需要进行网片取出，最常见于腹股沟疝修补术后。由于粘连、瘢痕和网片与周围组织的融合，再次手术取出网片具有一定的挑战性。机器人技术为解决这些复杂病例提供了一个多功能的平台，以增强暴露度。我们旨在分享使用新型机器人方法处理这些复杂病例的经验。
对 2016 年 3 月至 2020 年 1 月期间两位外科医生对因网片相关慢性疼痛或复发性腹疝而行机器人网片取出术（RoME）的患者进行描述性、回顾性分析。评估患者网片相关腹痛的缓解情况以及术后早期并发症。在复发的情况下，同期行疝修补术。
2016 年 3 月至 2020 年 1 月期间，29 例患者因网片相关慢性疼痛或复发性腹疝而行机器人网片取出术（RoME）。19 例（65.5%）患者曾行腹股沟疝修补术，10 例（34.5%）患者曾行腹疝修补术。网片取出的指征包括有或无疝复发的慢性疼痛。17 例（58.6%）患者术后疼痛改善或缓解（腹股沟疝修补术后为 63%，腹疝修补术后为 50%）。5 例（17.2%）患者在取出网片后需要进行网片加固。19 例（65.5%）患者行网片取出术，一期筋膜闭合或无需网片加固。平均随访 36.4 天。最常见的术后并发症是血清肿形成（6.8%），报告有 1 例复发（3.4%）。
对于因慢性瘢痕形成、粘连和网片与周围组织融合而导致的复杂病例，机器人网片取出术是安全的，并为这些复杂病例的同期疝修补术提供了有利的平台。
