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Robotically Assisted Laparoscopic Hernia RepairBrent Wogahn, MD There are over 500,000 hernia repairs in the United States each year. A large majority of them are done by the traditional conventional “open” method. That is, your surgeon makes an incision to repair the defect. With the advent of laparoscopic surgery over 25 years ago, more of the repairs are now being done using small incisions. More recently, with the development of the DiVinci Robot, this has taken laparoscopic surgery to a new level. What is a Hernia?There are more than 30 different types of hernias in the human body. Most repairs done, however, involve repair of the abdominal wall. The abdominal wall is made up of sheets of connective tissue and muscles that allow us to move, lift and bend. These layers keep the insides in and protect the belly contents. Weakness in the layers can be caused by surgical incisions, repetitive lifting and congenital defects. In the areas of weakness, the tissues thin and bulge. At times, the tissue tears completely leaving a hole in which bowels and other abdominal contents can pass through, much the same way as an inner tube can pass through a weak area in a tire. If things become stuck in this hole, they are trapped or “incarcerated”. Blood flow to the trapped intestines can become limited or stopped completely requiring emergent surgery to save an individual’s life. Hernias do not get better and generally increase in size over time. How do I know if I have a Hernia?Hernias are most commonly recognized as a bulge underneath your skin. This bulging may not cause you any discomfort; usually, there is associated pain when you lift heavy objects, cough, or strain with urination or bowel movements. Hernias can also cause pain without much activity. Sudden increases in pain in the area of the bulging, especially with associated nausea, vomiting, and/or diarrhea, can be signs of incarceration which can require an emergent operation to save your life. Options for RepairThe traditional surgical repair is to use a scalpel to make an incision, and this is still considered the “Gold Standard” of repair that all options are judged against. Because these repairs are generally very durable and safe, they can be done in sicker patients and usually require shorter anesthetic times. These repairs can be done with or without mesh. Weak or absent tissues may require the additional support that the mesh or screening material supply to prevent the reoccurrence of the hernia Laparoscopic techniques repair the same tears or openings using several small incisions and patch the defects with one of the assorted types of mesh or screening material. While sutures can be used to secure the repair, most surgeons use some sort of tacking device to tack the mesh into place. I have never liked any of the tacking methods as they do not seem to have the holding power for a durable repair. I prefer suturing and tying knots. This is very difficult and slow with typical laparoscopic equipment. Laparoscopic repairs do have the advantage of a quicker return to work and normal activity with decreased pain, since the incisions are smaller. The DiVinci Robotic AdvantageThe first improvement using the robot to assist with the repair of a hernia is the three dimensional optics or vision. This allows the surgeon to have far better depth perception and hand eye coordination. This is sort of like comparing the older video games of “Pac Man” or “Frogger” to today’s high tech games played by our children and grandchildren. The improved vision provides better safety during the surgery.
The robotic arms which the surgeon manipulates can rotate more than 360 degrees and have double jointed wrists which provide more agility than the human wrist. This allows the surgeon to use sutures and sew the defect closed directly or still use one of the many mesh or screening materials to patch over the hernia hole. Thus, making the same repair that open surgery provides but getting there via small incisions instead of a large one. In ConclusionThe DiVinci Robotic advancement of laparoscopic surgery has improved surgical care. The robot allows for bigger operations to be done laparoscopically, less pain after surgery, and potentially a quicker return to normal activity. However, not all people are candidates for this type of repair because of previous surgeries and/or current health concerns. Dr. Wogahn – Evergreen Surgical |
