January 16, 2019 by Laura Pincus and Patty Shillington
Robotic Hernia Repair on the Rise
While documented incidence of abdominal hernias varies greatly, researchers and surgeons generally agree that hernia repair is the most common procedure surgeons perform.
Now, research being conducted, in part by Baptist Health South Florida surgeons, supports the use of a minimally invasive approach to hernia repair using a surgical robot.
“We’re studying whether patients whose surgeons use a surgical robot to perform abdominal hernia repair do better than those whose surgeons use traditional laparoscopic or open repair,” said Jorge Rabaza, M.D., a Baptist Health general surgeon, investigator in the study and chief of surgery at South Miami Hospital. “Early indications, as published in Surgical Endoscopy in 2016, show robotic abdominal hernia repair is effective and safe.”
Types of Abdominal Hernias
Hernias occur when an organ, intestine or other internal soft tissue pushes through a hole in weakened muscle or connective tissue, creating a bulge under the skin. They are classified according to where they occur in the body or their underlying cause.
Dr. Rabaza says the most common type of hernia he sees is inguinal hernias, which occur in the groin area and can involve the bowel pushing through a hole in the abdominal wall. Inguinal hernias, according to a study published in BMJ (formerly the British Medical Journal) in 2008, affect 27 percent of men over their lifetime versus 3 percent of women over their lifetime.
Inguinal hernias can cause a bowel obstruction if the large intestine enters the hole and becomes trapped, or if the hernia cuts off the bowel’s blood supply, leading to tissue death. Dr. Rabaza says either of these instances prompts an emergency surgery to restore proper function to the bowel.
Umbilical hernias develop around the belly button, often the result of torn abdominal muscles, and have been known to occur in pregnancy, especially in mothers of multiples or in women who have had multiple pregnancies. Because of their location, these types of hernias are the most visible and unsightly, making elective surgical treatment common.
Like inguinal hernias, umbilical hernias, if not treated, can cause a bowel obstruction or bowel strangulation, resulting in an emergency surgery.
Incisional hernias originate from weakened muscle tissue that was cut through during prior surgeries. Similar to other types of abdominal hernias, they can appear as bulges but are located within the scar of an old incision. Dr. Rabaza says the surgical procedures known to sometimes create incisional hernias include gallbladder surgery, previous hernia repairs, colon surgery and Cesarean sections.
Epigastric hernias are named for their location between the chest and the belly button. These hernias occur in some newborns and result from the incomplete closure of the abdominal muscles. If an epigastric hernia is not recognized and repaired during childhood, adults with this type of hernia may experience growth of the hernia, discomfort or pain, as aging contributes to further weakening of the abdominal wall. Tissue can become entrapped in the hole and the protruding bulge can become red, purple or painful, signifying a strangulated hernia that needs to be surgically treated.
Benefits of Robotic Hernia Repair
No matter the type of hernia, Dr. Rabaza says his team’s research indicates robotic surgery, like laparoscopic surgery, can be considered for most types of hernia repairs, provided the hernias are not too large and are free of excessive scar tissue. Also, the patient must be in good health and able to tolerate general anesthesia, which is required during laparoscopic and robotic hernia repair surgery.
For people who fall outside of this high-risk group, Dr. Rabaza says, robotic hernia repair offers a quicker recovery with less pain and less swelling. He also notes that patients who have had their hernias repaired using the surgical robot controlled by him or his Baptist Health Surgical Group colleagues have had fewer recurrences of their hernias.
Dr. Rabaza credits the enhanced visualization of the patient’s internal anatomy through the robot’s high-definition, three-dimensional, magnified camera for these benefits. Surgeons can also manipulate the structures of the body using the wristed arms of the robot to access the hernia. Visualization and access to the hernia can be challenging with a traditional laparoscopic approach. And in recurrent inguinal hernias, he says, the robot allows surgeons to approach the hernia from a different angle, bypassing scar tissue that can create problems for the surgeon.
“We’re hopeful that our research will help set the standard of care for future repairs of abdominal hernias,” Dr. Rabaza said. “Minimally invasive surgery is a goal for many types of surgery today, and the robot has been shown as a tool we can use to effectively minimize complications and maximize results for our patients.”