Vogel Robert, Heinzelmann Frank, Büchler Peter, Mück Björn
Klinik für Allgemein-, Viszeral- und Kinderchirurgie-Klinikum Kempten, Kempten, Germany.
J Abdom Wall Surg. 2024 Nov 22;3:13055. doi: 10.3389/jaws.2024.13055. eCollection 2024.
There is a growing consensus on the benefits of retro-muscular (RM) mesh positioning, highlighted by its recommendation in the latest edition of EHS guidelines. The eTEP method has facilitated minimally invasive hernia repairs with retro-muscular mesh placement. With the increasing availability of robotic systems, there has been a corresponding increase in robotic adaptations of minimally invasive techniques involving retro-muscular mesh placement.
All patients who underwent robotic ventral hernia repair using the lateral extraperitoneal eTEP technique at Kempten Hospital between September 2019 and December 2023 were includes in the study. Preoperative characteristics, perioperative parameters, postoperative parameters, and hernia-specific parameters, were retrospectively analyzed using the hospital information system.
160 patients were operated using a lateral approach eTEP technique during the observation period, 111 (69.38%) for incisional hernia repair and 49 (30.63%) for primary hernia repair. 43 cases required TAR (30 unilateral TAR and 13 bilateral TAR). 139 patients had a medial (86.98%), seven patients (4.14%) a lateral and 14 patients (8.88%) a combined hernia defect. The median operative time was 143 min (range: 53 min-495 min). The median length of hospital stay was 3 days (range: 2-16). There was one intraoperative complication. The postoperative complication rate was 6.25% (10 patients), with 1.72% (2 patients) requiring reoperation. Sonographic follow-up examinations revealed seromas in 5 patients, with 4 located in the retromuscular mesh space and 1 in the former hernia sac. None of these seromas required surgical intervention.
The "lateral approach" of robotic eTEP provides a safe surgical method for treating ventral hernias using minimally invasive techniques and mesh augmentation in the retro-muscular space. Further studies are necessary to compare extraperitoneal with transperitoneal methods.
关于肌后（RM）补片放置的益处，人们的共识日益增加，最新版的EHS指南对其进行了推荐，这突出了该方法的优势。eTEP方法推动了采用肌后补片放置的微创疝修补术。随着机器人系统的日益普及，涉及肌后补片放置的微创技术的机器人适应性应用也相应增加。
纳入2019年9月至2023年12月期间在肯普滕医院采用外侧腹膜外eTEP技术接受机器人腹疝修补术的所有患者。使用医院信息系统对术前特征、围手术期参数、术后参数和疝特异性参数进行回顾性分析。
在观察期内，160例患者采用外侧入路eTEP技术进行手术，其中111例（69.38%）为切口疝修补，49例（30.63%）为原发性疝修补。43例需要进行TAR（30例单侧TAR和13例双侧TAR）。139例患者存在内侧疝缺损（86.98%），7例（4.14%）存在外侧疝缺损，14例（8.88%）存在联合疝缺损。中位手术时间为143分钟（范围：53分钟 - 495分钟）。中位住院时间为3天（范围：2 - 16天）。术中发生1例并发症。术后并发症发生率为6.25%（10例患者），其中1.72%（2例患者）需要再次手术。超声随访检查发现5例患者出现血清肿积液，4例位于肌后补片间隙，1例位于原疝囊内。这些血清肿积液均无需手术干预。
机器人eTEP的“外侧入路”为使用微创技术和在肌后间隙进行补片增强治疗腹疝提供了一种安全的手术方法。有必要进一步开展研究以比较腹膜外与经腹膜方法。
