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Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience.

Qazi HA, Rai BP, Do M, Rewhorn M, Häfner T, Liatsikos E, Kallidonis P, Dietel A, Stolzenburg JU - Cent European J Urol (2015)

Bottom Line: Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement.We await long-term follow-up data.Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.

ABSTRACT

Introduction: To describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes.

Material and methods: 12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure.

Results: Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data.

Conclusions: Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.

No MeSH data available.


Related in: MedlinePlus

Port placement for TEP hernia repair in combination with R-EERPE. 5 Ports are used: the pre-peritoneal space is created through a right paraumbilical incision and the optic trocar introduced; this is followed by three 8 mm trocars for the DaVinci System and one 12 mm assistant trocar superomedial to the right anterior superior iliac spine.
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Figure 0002: Port placement for TEP hernia repair in combination with R-EERPE. 5 Ports are used: the pre-peritoneal space is created through a right paraumbilical incision and the optic trocar introduced; this is followed by three 8 mm trocars for the DaVinci System and one 12 mm assistant trocar superomedial to the right anterior superior iliac spine.

Mentions: Our surgical technique for R-EERPE using a 4-arm DaVinci Si system, as well as laparoscopic TEP hernia repair, has been described previously [10, 11]. Our standard antibiotic prophylaxis is comprised of a second-generation intravenous cephalosporin at induction; no additional antibiotic prophylaxis was used. The patients were placed supine on the operating table, with the legs apart, in a 10-15 degree head-down tilt as demonstrated in Figure 1. A right paramedian port was initially introduced, through which a pre-peritoneal space was created using a balloon trocar. Then, under vision, three further 8 mm ports were placed for the robotic system along with an additional 12 mm port for the assistant, about 5 cm superomedial to the right anterior superior iliac spine (Figure 2).


Robot-assisted laparoscopic total extraperitoneal hernia repair during prostatectomy: technique and initial experience.

Qazi HA, Rai BP, Do M, Rewhorn M, Häfner T, Liatsikos E, Kallidonis P, Dietel A, Stolzenburg JU - Cent European J Urol (2015)

Port placement for TEP hernia repair in combination with R-EERPE. 5 Ports are used: the pre-peritoneal space is created through a right paraumbilical incision and the optic trocar introduced; this is followed by three 8 mm trocars for the DaVinci System and one 12 mm assistant trocar superomedial to the right anterior superior iliac spine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526615&req=5

Figure 0002: Port placement for TEP hernia repair in combination with R-EERPE. 5 Ports are used: the pre-peritoneal space is created through a right paraumbilical incision and the optic trocar introduced; this is followed by three 8 mm trocars for the DaVinci System and one 12 mm assistant trocar superomedial to the right anterior superior iliac spine.
Mentions: Our surgical technique for R-EERPE using a 4-arm DaVinci Si system, as well as laparoscopic TEP hernia repair, has been described previously [10, 11]. Our standard antibiotic prophylaxis is comprised of a second-generation intravenous cephalosporin at induction; no additional antibiotic prophylaxis was used. The patients were placed supine on the operating table, with the legs apart, in a 10-15 degree head-down tilt as demonstrated in Figure 1. A right paramedian port was initially introduced, through which a pre-peritoneal space was created using a balloon trocar. Then, under vision, three further 8 mm ports were placed for the robotic system along with an additional 12 mm port for the assistant, about 5 cm superomedial to the right anterior superior iliac spine (Figure 2).

Bottom Line: Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement.We await long-term follow-up data.Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Leipzig, Leipzig, Germany.

ABSTRACT

Introduction: To describe the technique of total extraperitoneal inguinal hernia repair performed during Robot-assisted Endoscopic Extraperitoneal Radical Prostatectomy (R-EERPE) and to present the initial outcomes.

Material and methods: 12 patients underwent inguinal hernia repair during 120 R-EERPEs performed between July 2011 and March 2012. All patients had a clinically palpable inguinal hernia preoperatively. The hernia was repaired using a Total Extraperitoneal Patch (TEP) at the end of the procedure.

Results: Sac dissection and mesh placement was simpler compared to conventional laparoscopy due to improved, magnified, 3-D vision along with 7° of movement, and better control of mesh placement. The median operating time was 185 minutes, with on average, an additional 12 minutes incurred per hernia repair. The median blood loss for the procedures was 250 ml, and the mean pathological prostate weight was 55 gm. No additional blood loss was noted and there were no postoperative complications. None of the patients had a recurrence at 12 months. We await long-term follow-up data.

Conclusions: Robot-assisted TEP is feasible and should be considered in patients with hernia at the time of R-EERPE.

No MeSH data available.


Related in: MedlinePlus