Robot-assisted treatment of epigastric hernias with a suprapubic approach

Abstract BackgroundRobotic ventral hernia repair has shown itself to be feasible and safe in abdominal wall surgery. Presently, the ports are commonly placed laterally to meet the distance from the fascial defect. The aim of our study is to reort our experience of epigastric hernias treatment with the trocars’ insertion in the suprapubic region.MethodsA retrospective search on a prospectively collected dataset was performed to identify patients treated for primary or incisional hernias of the epigastric region with a robotic-assisted approach. In all cases, three 8-mm trocars were inserted in the suprapubic area and the preperitoneal or the posterior rectus sheath spaces dissected to ensure a proper mesh overlap. After hernia reduction, the fascia was closed with a running suture, the mesh placed and the peritoneum sutured.ResultsTwelve patients were selected. Median age was 58.5 years (interquartile range (IQR) 47.8–67.3) and four patients were male (33.3%). All patients were referred to surgery because of pain. The median measure of the hernia defect was 30 mm (IQR 13.75-31), median larger mesh diameter was 13.5 cm (IQR 9.5–15.0) and median operative time was 136.5 minutes (IQR 120-186.5). No intraoperative complication or conversion to open surgery occurred. Postoperatively, two patients presented a seroma and the median length of hospital stay was 2.0 days (IQR 1.75-3).ConclusionsIn the robot-assisted treatment of hernias of the epigastric region, a suprapubic port placement can be considered instead of a lateral one. Further studies are needed to assess the benefits and limitations of such technique.Trial registrationRetrospectively registered (Comitato Etico Cantonale Ticino n. 2019-01132 CE3495)