Liu Yao Z, Luhrs Andrew, Tindal Elizabeth, Chan Stephanie, Gabinet Nicholas, Giorgi Marcoandrea
Department of Surgery, Brown University, Providence, RI, USA.
, 195 Collyer Street, Suite 302, Providence, RI, 02904, USA.
Surg Endosc. 2024 Apr;38(4):2260-2266. doi: 10.1007/s00464-024-10718-w. Epub 2024 Mar 4.
Though robotic adoption for eTEP surgery has decreased technical barriers to minimally invasive repairs of large ventral hernias, relatively few studies have examined outcomes of robotic-specific eTEP surgery. This study evaluates safety, feasibility, and early outcomes of ERAS/same-day discharge protocols for robotic eTEP ventral hernia repairs.
A retrospective chart review was performed for all robotic eTEP hernia surgeries at a single institution between 2019 and 2022. Analysis included patient demographics, hernia characteristics, intraoperative data, and post-operative outcomes at 30 days. ERAS protocol included: judicious use of urinary catheters with removal at end of case if placed, bilateral transversus abdominus plane (TAP) blocks, post-operative abdominal wall binder, and opioid-sparing perioperative analgesia. Patients were discharged same day from post-anesthesia care unit (PACU) if they lacked comorbidities requiring observation post-anesthesia and demonstrated stable vital signs, adequate pain control, ability to void, and ability to ambulate. Hospital length of stay (LOS) was considered 0 for same-day PACU discharges or hospitalizations < 24 h.
102 patients were included in this case series. 69% (70/102) of patients were discharged same-day (mean LOS 0.47 ± 0.80 days). Within 30 post-operative days, 3% (3/102) of patients presented to the ER, 2% (2/102) were readmitted to the hospital, and 1% (1/102) required reoperation. There was 1 serious complication (Clavien-Dindo grade 3/4) with an aggregate complication rate of 7.8%.
Our initial experience with ERAS protocols and same-day discharges after robotic eTEP repair demonstrates this approach is safe and feasible with acceptable short-term patient outcomes. Compared to traditional open surgery for large ventral hernias, robotic eTEP may enable significant reductions in hospital LOS as adoption increases.
尽管机器人辅助技术应用于内镜下经腹膜前修补术（eTEP）降低了大型腹疝微创修复的技术障碍，但相对较少的研究探讨了机器人辅助特定的eTEP手术的结果。本研究评估了机器人辅助eTEP腹疝修补术的加速康复外科（ERAS）/当日出院方案的安全性、可行性和早期结果。
对2019年至2022年期间在单一机构进行的所有机器人辅助eTEP疝手术进行回顾性病历审查。分析包括患者人口统计学、疝的特征、术中数据以及术后30天的结果。ERAS方案包括：谨慎使用导尿管，若放置则在手术结束时拔除；双侧腹横肌平面（TAP）阻滞；术后使用腹壁束腹带；以及采用减少阿片类药物的围手术期镇痛。如果患者没有需要麻醉后观察的合并症，且生命体征稳定、疼痛控制良好、能够排尿和行走，则在麻醉后恢复室（PACU）当日出院。当日从PACU出院或住院时间<24小时的患者，住院时间（LOS）计为0天。
本病例系列纳入了102例患者。69%（70/102）的患者当日出院（平均LOS 0.47±0.80天）。术后30天内，3%（3/102）的患者到急诊就诊，2%（2/102）的患者再次入院，1%（1/102）的患者需要再次手术。发生1例严重并发症（Clavien-Dindo 3/4级），总并发症发生率为7.8%。
我们在机器人辅助eTEP修补术后采用ERAS方案和当日出院的初步经验表明，这种方法是安全可行的，患者短期预后可接受。与大型腹疝的传统开放手术相比，随着机器人辅助eTEP的应用增加，可能会显著缩短住院LOS。
