Hybrid robotic transversus abdominis release versus open: propensity-matched analysis of 30-day outcomes.

PURPOSE: To examine the hospital length of stay (LOS) and 30 day outcomes of hybrid robotic transversus abdominis release (hrTAR) compared with open transversus abdominis release (oTAR). METHODS: Patients receiving hrTAR were selected from the AHSQC database and propensity matched with a contemporary cohort of oTAR patients. RESULTS: The cohort included 95 hrTAR and 285 oTAR patients. There was a significantly shorter median LOS in the hrTAR cohort (3 vs. 5 days, p < 0.001). The rate of surgical site occurrences in the hrTAR cohort was also lower than for oTAR (5% vs. 15%, p = 0.015). Readmission rates were not different between hrTAR and oTAR (6% vs. 8%, p = 0.65). CONCLUSION: hrTAR demonstrates improved LOS compared to oTAR as well as fewer surgical site related occurrences. Further studies are needed to investigate the etiology behind the improved LOS and to confirm appropriate long-term outcomes from hybrid robotic TAR.

Hybrid robotic-assisted transversus abdominis release versus open transversus abdominis release: a comparison of short-term outcomes.

BACKGROUND: Although the open transversus abdominis release (oTAR) is an effective operation for large ventral hernias, it is historically associated with a relatively long length of stay. Robotic retromuscular transversus abdominis release (rTAR) allows minimally invasive repair of complex ventral hernias with shorter length of stay (LOS) compared to open repairs (TAR), but hybrid robotic TAR (hrTAR), partial open intervention via incision through the overlying hernia sac for fascial closure, may be required to accomplish effective repair of large defects. We compare LOS and short-term outcomes of a cohort of our hrTAR patients to our historical oTAR patients. METHODS: All hrTAR performed in our institution between November 2015 and July 2017 contained in a prospectively maintained robotic database and/or in the Americas Hernia Society Quality Collaborative (AHSQC) database were analyzed. Additionally, open TAR patients maintained in a prospective personal database and/or in the AHSQC from September 2013 to August 2016 were similarly analyzed and compared with hrTAR patients. RESULTS: 134 TAR patients and 49 hrTAR patients were analyzed. Age, gender, BMI, HTN, DM, and proportion of recurrent hernia were not significantly different. Hernia width (14.3 cm vs 14.0 cm, p = 0.80) and length (21.9 vs 20.0 cm, p = 0.10) were similar between groups. Mean operative times did not differ significantly between groups (274 min vs 304 min p = 0.06). Thirty day wound events including SSI and SSOPI were not significantly different between groups. LOS was significantly shorter in the hrTAR group (3 vs 7 days, p ≤ 0.001). CONCLUSION: Hybrid robotic transversus abdominis release (hrTAR) may be performed with significantly lower LOS, similar wound morbidity and complication profile compared to open TAR. This novel surgical technique provides a minimally invasive option for a challenging subset of large ventral hernias which cannot be treated effectively with a purely robotic approach and would traditionally require and open operation.