Advancing surgical practices: Combining lumbar hernia and umbilical hernia repairs with robotic assistance

In surgical practice, innovation and efficiency are crucial, especially when addressing complex cases involving multiple hernias. Robotic assistance in surgery offers a method to perform simultaneous repairs of lumbar and umbilical hernias, streamlining the process and potentially improving patient outcomes. The goal is to provide a balanced perspective on the practical benefits and considerations of robotic assistance for combined hernia repairs.

Case approach and planning

A recent patient presented with both a lumbar hernia and an umbilical hernia, necessitating a thoughtful approach to address both conditions effectively. Traditionally, these cases might be managed in separate procedures, but robotic assistance provided the opportunity to handle them concurrently.

We used a single docking system and adjusted port positions to address both hernias, completing the procedures with only four ports. A 15×20 cm mesh was placed for the lumbar hernia and a 30×24 cm mesh for the umbilical hernia. This approach minimised the invasiveness of the procedure, reducing the patient’s overall recovery time and exposure to anaesthesia.

Technical considerations

Robotic surgery’s precision is beneficial when performing combined procedures. By strategically placing lateral ports and using techniques such as Transabdominal Preperitoneal (TAPP) and Total Extraperitoneal (TEP) repairs, the risk of complications, such as gallbladder spillage, can be managed effectively. This precision ensures both hernias are addressed without compromising the integrity of either repair.

Using a monofilament mesh in the TAPP plane provided a cost-effective solution, potentially reducing overall expenses compared to traditional methods. The use of a single docking system further simplified the procedure, allowing for seamless transitions between the different surgical areas. This efficiency in the operating room translates to reduced operative time and potentially lower costs for the healthcare system.

Clinical outcomes

Combining hernia repairs in a single surgical session can reduce the patient’s overall exposure to anaesthesia and the risks associated with multiple surgeries. This approach may also result in cost savings and improved cosmetic outcomes due to the placement of incisions. By minimising the number of incisions, patients often experience less postoperative pain and faster recovery times, enhancing their overall experience and satisfaction.

Ensuring optimal mesh placement and minimising the recurrence risk is a focus. Addressing both hernias in one session can improve patient satisfaction and outcomes, especially for those who might be at high risk for multiple surgeries. By reducing the need for additional surgical interventions, patients can avoid the cumulative risks and stress associated with repeated procedures.

Recommendations for surgeons

Patient selection is crucial for the success of combined procedures. Ideal candidates typically present with concurrent hernias and obesity. By carefully selecting patients who would benefit most from combined hernia repairs, surgeons can optimise outcomes and reduce the likelihood of complications. Understanding patient profiles and their specific needs helps in tailoring the surgical approach effectively.

Technical proficiency in robotic techniques and a solid understanding of TAPP and TEP procedures are essential for surgeons considering combined hernia repairs. Surgeons may need to invest in additional training and continuous learning to ensure they are well-versed in these advanced techniques. Mastery in these areas can lead to more efficient surgeries and better patient outcomes.

Preoperative planning is another critical aspect. Detailed planning of port placement and mesh size tailored to the patient’s specific anatomy and hernia characteristics can significantly influence the success of the procedure. Surgeons should take the time to meticulously map out the surgical approach, considering all variables to optimise the results.

Insurance and cost considerations are also important. While insurance companies may not always recognise combined procedures as separate, it is beneficial to highlight the overall cost savings and reduced patient morbidity in insurance claims. Educating insurance providers on the advantages of these advanced techniques can help in getting appropriate coverage and support for patients undergoing combined hernia repairs.

Looking ahead

As the surgical community continues to embrace technological advancements, the integration of robotics in combined hernia repairs represents a practical and forward-thinking approach. The potential for improved patient outcomes, cost savings, and operational efficiencies makes this technique an attractive option for surgeons.

Sharing knowledge and experiences within the surgical community is key to broader adoption. As more surgeons become proficient in these techniques and understand their benefits, the standard of care can evolve to include these advanced methods. Peer-to-peer learning, attending workshops, and participating in professional development opportunities are essential steps in this process.

Moreover, ongoing research and data collection are vital. By documenting outcomes and sharing results, surgeons can build a robust evidence base that supports the efficacy and safety of combined hernia repairs using robotic assistance. This evidence can further influence guidelines and recommendations, promoting the best practices in hernia repair surgery.

The integration of robotics in combined hernia repairs represents a practical advancement in surgical practice. By adopting these techniques, surgeons can offer patients improved outcomes and more efficient care. As we continue to innovate and refine our methods, the potential to enhance patient care and optimise surgical outcomes remains a driving force in the evolution of modern surgery.