Lima Diego L, Berk Robin, Cavazzola Leandro T, Malcher Flavio
Department of Surgery, Montefiore Medical Center, The Bronx, New York, USA.
Department of Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
J Laparoendosc Adv Surg Tech A. 2023 Jan;33(1):81-86. doi: 10.1089/lap.2022.0270. Epub 2022 Jun 23.
The enhanced-view extraperitoneal (eTEP) technique was first described for minimally invasive inguinal hernia repairs and later for laparoscopic ventral hernia repair. The objective of this study was to report our early experience and learning curve (LC) with the robotic-assisted eTEP (R-eTEP) approach. We performed a retrospective analysis of patients undergoing R-eTEP repair for ventral hernias from December 2018 to September 2021. A single surgeon operative time (OT)-based LC was evaluated. A total of 81 patients underwent an R-eTEP from December 2018 to September 2021. Sixty-five patients were ultimately included in our analysis. Fifty-seven patients underwent eTEP-Rives-Stoppa (RS) and 8 patients underwent eTEP-transversus abdominis release (TAR). The median age in the whole cohort was 57 years (interquartile range [IQR] 51.5-64.5 years) with no difference between the groups. The median body mass index (BMI) was 31 kg/m (IQR 27-34.7 kg/m) in the eTEP-RS group and 29.7 kg/m (IQR 28.5-31 kg/m) in the eTEP-TAR group. There were 36 incisional hernias (63%) in the eTEP-RS group and 8 (100%) in the eTEP-TAR group. There were 14 recurrent hernias (25%) in the eTEP-RS group and 2 (25%) in the eTEP-TAR group. The LC was evaluated only in the eTEP-RS cases. We divided the cohort into 3 chronological groups (G1, G2, and G3), including 19 cases each. The median OT in each group was 177 (IQR 147-200), 153 (IQR 127-187), and 125 minutes (IQR 106-152 minutes), respectively. There was no difference in the median OT between G1 and G2 ( = .390). G3 had a shorter median OT than G2 ( = .02) and G1 ( = .001). There was no difference between these groups in median age, BMI, defect area, defect width, and mesh area. The R-eTEP approach has been shown to be safe and feasible for ventral and incisional hernia repairs. A statistically significant decrease in OT was observed after 38 cases.
强化视野腹膜外（eTEP）技术最初被描述用于微创腹股沟疝修补术，后来也用于腹腔镜腹疝修补术。本研究的目的是报告我们在机器人辅助eTEP（R-eTEP）方法方面的早期经验和学习曲线（LC）。我们对2018年12月至2021年9月接受R-eTEP腹疝修补术的患者进行了回顾性分析。评估了基于单一外科医生手术时间（OT）的LC。2018年12月至2021年9月共有81例患者接受了R-eTEP手术。最终65例患者纳入我们的分析。57例患者接受了eTEP-里夫斯-斯托帕（RS）手术，8例患者接受了eTEP-腹横肌松解（TAR）手术。整个队列的中位年龄为57岁（四分位间距[IQR]51.5 - 64.5岁），两组之间无差异。eTEP-RS组的中位体重指数（BMI）为31 kg/m²（IQR 27 - 34.7 kg/m²），eTEP-TAR组为29.7 kg/m²（IQR 28.5 - 31 kg/m²）。eTEP-RS组有36例切口疝（63%），eTEP-TAR组有8例（100%）。eTEP-RS组有14例复发性疝（25%），eTEP-TAR组有2例（25%）。仅在eTEP-RS病例中评估了LC。我们将队列按时间顺序分为3组（G1、G2和G3），每组19例。每组的中位OT分别为177分钟（IQR 147 - 200）、153分钟（IQR 127 - 187）和125分钟（IQR 106 - 152分钟）。G1和G2之间的中位OT无差异（P = 0.390）。G3的中位OT比G2短（P = 0.02），比G1短（P = 0.001）。这些组在中位年龄、BMI、缺损面积、缺损宽度和补片面积方面无差异。R-eTEP方法已被证明用于腹疝和切口疝修补是安全可行的。38例手术后观察到OT有统计学意义的下降。
