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For an belly wall hernia restore, also referred to as a ventral hernia restore, the commonest surgical approaches have been laparoscopic and open strategies. However a brand new method for repairing hernias has been steadily rising in recognition: the surgical robotic.
Supporters of utilizing the robotic technique state a number of benefits over conventional laparoscopic and open approaches, together with improved surgeon ergonomics.
However there could also be downsides to the expertise which might be going undiscussed.
In a analysis article printed in JAMA Surgical procedure, Brian Fry, M.D., M.S., a common surgical procedure resident at College of Michigan Well being and colleagues in contrast hernia recurrence charges after present process robotic, laparoscopic and open repairs.
The examine analyzed a big pattern of Medicare-insured sufferers present process ventral hernia repairs and located that these present process repairs utilizing a robotic method had larger charges of their hernias recuring when in comparison with sufferers who underwent restore with a laparoscopic or open method.
Nevertheless, regardless of the upper recurrence fee for these present process robotic repairs, the charges have been only one.1% larger than laparoscopic repairs and 0.7% larger than open repairs at 10 years after surgical procedure.
“Despite evidence for its benefit in certain surgical procedures such as prostate surgery, our data adds to the large body of work demonstrating no substantial clinical benefit when using the robot for ventral hernia repair on a large scale,” stated Fry.
“We are undoubtedly capturing an element of the learning curve for robotics that was present when laparoscopy first hit the scene. We initially saw higher complication and hernia recurrence rates when laparoscopic hernia repairs were first introduced, but we still pushed to overcome the ‘learning curve’ of people picking up the procedure because it was a paradigm shift in hernia care.”
Robotic and laparoscopic hernia repairs use equally small cuts within the pores and skin, however the robotic permits three-d imaginative and prescient and articulating wrist expertise that makes it simpler for a surgeon to see and stitch.
However analysis has proven that robotic repairs take longer, and the expertise of the robotic prices rather more than conventional laparoscopy.
Upon preliminary introduction of the robotic surgical procedure for hernias, size of keep and postoperative restoration instances have been vastly decreased because of a lot smaller incisions, and the inferior preliminary outcomes as a surgeon labored by way of their studying curve have been offset by clear advantages.
Nevertheless, Fry states that it is a lot more durable to argue that robotics gives the same paradigm-shifting benefit over laparoscopy that will justify doubtlessly inferior outcomes.
Fry and his workforce of researchers consider the incremental advantage of the robotic, significantly as it’s at the moment getting used nationwide inside hernia restore, is value questioning.
“More work needs to be done to understand which patients, hernias and specific operative techniques are best able to leverage the robot’s strengths and provide true clinical benefit to the patient,” stated Fry.
“The robot may provide benefit for more advanced operative techniques used to repair very large or complex hernias, as these repairs are rarely attempted laparoscopically. However, most hernia repairs are performed by general surgeons out in the community, not by hernia specialists at large hospital systems.”
Based on Fry, robotic surgical hernia restore is right here to remain and it is as much as surgeons to determine how we are able to finest harness the expertise to maximise its potential advantages.
“With the rapid uptake and popularity of robotic hernia repair, it is important that we figure out how to best train and credential surgeons on the platform as well as carefully select patients and techniques that leverage the true advantages of the technology.”
Extra info:
Brian T. Fry et al, Surgical Method and Lengthy-Time period Recurrence After Ventral Hernia Restore, JAMA Surgical procedure (2024). DOI: 10.1001/jamasurg.2024.1696
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Are robotic hernia repairs nonetheless within the ‘studying curve’ part? (2025, March 5)
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