Department of Surgery, Montefiore Medical Center, Bronx, New York, USA.
Department of Surgery, Bronxcare Healthcare System, Bronx, New York, USA.
J Laparoendosc Adv Surg Tech A. 2022 Oct;32(10):1092-1096. doi: 10.1089/lap.2022.0303. Epub 2022 Aug 25.
The laparoscopic intracorporeal rectus aponeuroplasty (LIRA) was developed as an alternative for minimally invasive ventral hernia repair. This technique allows the closure of the defect and restoration of the midline without tension by plication of both aponeurosis of the abdominal rectus muscles combined with a minimally invasive intraperitoneal underlay mesh repair. The objective of this study is to report our early experience with the Robotic-LIRA (R-LIRA) technique and its safety and short-term efficacy. We performed a retrospective analysis of patients undergoing R-LIRA repair for ventral hernias from March 2019 to April 2022. Eight patients underwent R-LIRA from March 2019 to April 2022. Median age was 47 years (interquartile range [IQR] 34.5-62.8). Median body mass index was 34.2 kg/m (IQR 29.9-35.2). Four patients (50%) had a primary ventral hernia being one M2, two M3, and one M2/M3. There were three incisional hernias, being one recurrent, 6 patients (75%) had associated diastasis of the rectus muscle and 1 patient presented pure diastasis. The median hernia width was 4 cm (IQR 2-6), and the median defect area was 16 cm (IQR 4-42). The median mesh area was 290 cm (IQR 211.2-300). In all cases, a barbed suture was also used for mesh fixation, and tackers were added in 4 cases. The median operative time was 172 minutes (IQR 139.8-293.3). The median length of stay was 0.5 days (IQR 0-1.8), and the median follow-up was 20 days (IQR 16-46). The R-LIRA has been shown to be safe and feasible for ventral and incisional hernia repairs with or without Diastasis of the Rectus Abdominis Muscle in the short term.
腹腔镜腹直肌鞘内修补术（LIRA）作为微创腹疝修补的替代方法而发展。该技术通过将腹直肌的腹直肌鞘折叠，结合微创腹腔内底层补片修复，在无张力的情况下闭合缺损并恢复中线。本研究的目的是报告我们早期使用机器人-LIRA（R-LIRA）技术及其安全性和短期疗效的经验。我们对 2019 年 3 月至 2022 年 4 月期间接受 R-LIRA 修复腹疝的患者进行了回顾性分析。2019 年 3 月至 2022 年 4 月期间，8 例患者接受 R-LIRA 治疗。中位年龄为 47 岁（四分位距 [IQR] 34.5-62.8）。中位体重指数为 34.2kg/m（IQR 29.9-35.2）。4 例（50%）为原发性腹疝，其中 M2 1 例，M3 2 例，M2/M3 1 例。有 3 例切口疝，其中 1 例为复发性疝，6 例（75%）合并腹直肌分离，1 例仅存在分离。中位疝宽为 4cm（IQR 2-6），中位缺损面积为 16cm（IQR 4-42）。中位补片面积为 290cm（IQR 211.2-300）。所有病例均使用带刺缝线固定补片，4 例加用缝合钉。中位手术时间为 172 分钟（IQR 139.8-293.3）。中位住院时间为 0.5 天（IQR 0-1.8），中位随访时间为 20 天（IQR 16-46）。R-LIRA 在短期内被证明是安全可行的，可用于修复腹疝和切口疝，无论是否合并腹直肌分离。
