Tagerman Daniel, Nessen Michelle, Lima Diego L, Chin Ryan, Hindosh Nawaf, Solomon Zachary, Pereira Xavier, Sreeramoju Prashanth, Malcher Flavio
General Surgery, Montefiore Medical Center, Bronx, New York, USA.
General Surgery, Saint Francis Hospital, Hartford, Connecticut, USA.
J Laparoendosc Adv Surg Tech A. 2025 Jul;35(7):531-537. doi: 10.1089/lap.2025.0051. Epub 2025 May 26.
This work evaluated outcomes of robotic inguinal hernia repair (RIHR) in a single-institution study comparing surgeons with varying robotic experience. A retrospective study of all patients with RIHR performed between July 2016 and September 2021 at a single institution was performed. Baseline characteristics and outcomes between surgeons with >5 years of robotic experience (ERS) were compared with those with <5 years (NRS). A total of 297 cases of RIHR were performed. Mean age was 58.3 years (standard deviation [SD] 15.3) with a strong male predominance (88.2%). Forty-four patients (14.8%) had a previous repair, 87 (29.3%) underwent bilateral repair, and mean body mass index was 27.7 (SD 4.8). Sixty cases were performed by one ERS surgeon, and the remaining 237 cases were performed by eight NRS. ERS had more recurrent hernias (38.3% versus 8.9%, < .001), previous abdominal surgery (48% versus 25%, < .001), and more often had bilateral inguinal hernias (42% versus 26%, = .018). Incarcerated hernias were more commonly repaired by ERS compared with NRS (35% versus 8.9%, < .001). Mean operative time was higher for ERS (132.8 minutes versus 106.2, < .001). ERS was associated with more intraoperative complications (10% versus 0%, < .001) as well as 30-day complications (6.7% versus 1.7%, = .033); however, these were of minimal clinical significance. While ERS had a higher rate of radiographical recurrence (6.7% versus 3.0%, < .001) after 30 days, there was no difference in clinical concern for recurrence. While ERS may approach more complex situations, RIHR is a safe approach for both novice and experienced robotic surgeons.
这项研究在一项单机构研究中评估了机器人腹股沟疝修补术（RIHR）的结果，该研究比较了具有不同机器人手术经验的外科医生。对2016年7月至2021年9月期间在单一机构进行的所有RIHR患者进行了回顾性研究。将具有超过5年机器人手术经验的外科医生（ERS）与经验不足5年的外科医生（NRS）的基线特征和结果进行了比较。共进行了297例RIHR手术。平均年龄为58.3岁（标准差[SD]15.3），男性占主导（88.2%）。44例患者（14.8%）曾接受过修补术，87例（29.3%）接受双侧修补术，平均体重指数为27.7（SD 4.8）。60例手术由一名ERS外科医生进行，其余237例由八名NRS外科医生进行。ERS组复发性疝更多（38.3%对8.9%，P<0.001），既往有腹部手术史的更多（48%对25%，P<0.001），双侧腹股沟疝也更常见（42%对26%，P=0.018）。与NRS相比，ERS组嵌顿疝的修补更为常见（35%对8.9%，P<0.001）。ERS组的平均手术时间更长（132.8分钟对106.2分钟，P<0.001）。ERS组术中并发症更多（10%对0%，P<0.001）以及30天并发症更多（6.7%对1.7%，P=0.033）；然而，这些并发症的临床意义极小。虽然ERS组在30天后影像学复发率更高（6.7%对3.0%，P<0.001），但在复发的临床关注方面没有差异。虽然ERS组可能会处理更复杂的情况，但RIHR对于新手和经验丰富的机器人外科医生来说都是一种安全的手术方法。
