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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

Creation and placement of the prolene mesh for a right sided inguinal hernia. Figure 3(A). A Prolene mesh is trimmed to measure 10 cm x 15 cm. A cut is made from the distal end of the mesh and a hole, to accommodate the cord structures, is made at the end of this cut as shown. A flap is placed medial to the cut and held in position by a suture. The mesh is rolled and a short and long tie hold the medial and lateral aspect respectively. Figure 3(B). The prolene mesh is unfurled so that it covers the fascial defect; the flap is unrolled to cover the cut through the mesh and the hole allows for the cord structures to pass through. It is secured in place by the peritoneum without need for suturing or stapling.
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Figure 0003: Creation and placement of the prolene mesh for a right sided inguinal hernia. Figure 3(A). A Prolene mesh is trimmed to measure 10 cm x 15 cm. A cut is made from the distal end of the mesh and a hole, to accommodate the cord structures, is made at the end of this cut as shown. A flap is placed medial to the cut and held in position by a suture. The mesh is rolled and a short and long tie hold the medial and lateral aspect respectively. Figure 3(B). The prolene mesh is unfurled so that it covers the fascial defect; the flap is unrolled to cover the cut through the mesh and the hole allows for the cord structures to pass through. It is secured in place by the peritoneum without need for suturing or stapling.

Mentions: A 10 cm by 15 cm Primalene® (B:Braun) mesh was prepared for the hernia repair as demonstrated in Figure 3(A). A 6 cm vertical cut, with a 0.5 cm hole for the cord structures, was made and covered by a further flap of mesh. The flap was tacked down by a single suture and the whole mesh was rolled up to facilitate introduction and placement. A long tie was placed over the lateral aspect of the rolled mesh, while a shorter tie held the medial aspect in its rolled position. The mesh was introduced by the assistant through the 12 mm trocar and subsequent unfurling and placement was carried out entirely by the surgeon. The sutures were cut and the mesh was unrolled as shown in Figure 3(B). The mesh covered the visible defect, medial or lateral to the spermatic cord and was snug around the cord structures, extending from the midline to the anterior superior iliac spine laterally. No sutures or tacks were used to hold the mesh, as it was stabilized by the cord structures and snugged in place by the peritoneum as the pre-peritoneal space collapsed at the completion of the procedure.


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)

Creation and placement of the prolene mesh for a right sided inguinal hernia. Figure 3(A). A Prolene mesh is trimmed to measure 10 cm x 15 cm. A cut is made from the distal end of the mesh and a hole, to accommodate the cord structures, is made at the end of this cut as shown. A flap is placed medial to the cut and held in position by a suture. The mesh is rolled and a short and long tie hold the medial and lateral aspect respectively. Figure 3(B). The prolene mesh is unfurled so that it covers the fascial defect; the flap is unrolled to cover the cut through the mesh and the hole allows for the cord structures to pass through. It is secured in place by the peritoneum without need for suturing or stapling.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Creation and placement of the prolene mesh for a right sided inguinal hernia. Figure 3(A). A Prolene mesh is trimmed to measure 10 cm x 15 cm. A cut is made from the distal end of the mesh and a hole, to accommodate the cord structures, is made at the end of this cut as shown. A flap is placed medial to the cut and held in position by a suture. The mesh is rolled and a short and long tie hold the medial and lateral aspect respectively. Figure 3(B). The prolene mesh is unfurled so that it covers the fascial defect; the flap is unrolled to cover the cut through the mesh and the hole allows for the cord structures to pass through. It is secured in place by the peritoneum without need for suturing or stapling.
Mentions: A 10 cm by 15 cm Primalene® (B:Braun) mesh was prepared for the hernia repair as demonstrated in Figure 3(A). A 6 cm vertical cut, with a 0.5 cm hole for the cord structures, was made and covered by a further flap of mesh. The flap was tacked down by a single suture and the whole mesh was rolled up to facilitate introduction and placement. A long tie was placed over the lateral aspect of the rolled mesh, while a shorter tie held the medial aspect in its rolled position. The mesh was introduced by the assistant through the 12 mm trocar and subsequent unfurling and placement was carried out entirely by the surgeon. The sutures were cut and the mesh was unrolled as shown in Figure 3(B). The mesh covered the visible defect, medial or lateral to the spermatic cord and was snug around the cord structures, extending from the midline to the anterior superior iliac spine laterally. No sutures or tacks were used to hold the mesh, as it was stabilized by the cord structures and snugged in place by the peritoneum as the pre-peritoneal space collapsed at the completion of the procedure.

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