Technical feasibility of robot-assisted ventral hernia repair.

BACKGROUND: The da Vinci robotic laparoscopic incisional hernia repair with intracorporeal closure of the fascial defect and circumferential suturing of the mesh may offer an alternative to current fascial closure and transabdominal sutures and tackers. METHODS: From 2009 to 2011, a retrospective review of 13 patients with a mean age of 51 years, median body mass index (BMI) of 31.53 kg/m(2), and small and medium-sized ventral hernias (mean fascial defect 37.39 cm(2)) were treated with the da Vinci robot system using intracorporeal primary closure of the fascial defect with a running O-absorbable suture followed by underlay mesh fixation using a continuous running, circumferential, nonabsorbable suture. This study aimed to assess the technical feasibility of the procedure. In addition, the operating time and specific morbidity of postoperative pain, and long-term recurrence were recorded. RESULTS: The mean operating time was 131 min. There were no conversions to open or standard laparoscopic techniques. There were no postoperative deaths. The overall morbidity rate was 13%. One patient remained in hospital for pain control, and another experienced urinary retention that required a Foley catheter. The mean hospital stay was 2.4 days. During a median follow-up period of 23 months, one of the patients experienced a recurrent hernia. None experienced chronic suture site pain or discomfort. CONCLUSIONS: This is a retrospective series review of robot-assisted ventral hernia repair using intracorporeal primary closure followed by continuous running, circumferential fixation. The findings show that this technique is feasible and may not be associated with chronic postoperative pain. Further evaluation is needed, and long-term data are lacking to assess the benefit to the patient, but this series can be the basis for future studies.

Robotic-assisted Roux-en-Y gastric bypass: update from 2 high-volume centers.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) is a challenging operation in the most experienced hands. Robotic surgery allows the capabilities of the minimally invasive surgeon to be extended. An increasing number of robotic gastric bypasses are being performed each year with the assumption that the complication rates are decreased. The objectives of the present study were to review the results of robotic-assisted RYGB (RARYGB) from 2 high-volume centers, including 1 university and 1 private practice. METHODS: We report the most recently compiled, largest series of RARYGB in the world to show the effectiveness, morbidity, and mortality of this method. Databases were searched for patients undergoing RARYGB from 2002 to 2010, and the endpoints were recorded. RESULTS: A total of 1100 RARYGBs matched our search. The patients had a mean preoperative age of 46.9 years, mean weight of 131.9 kg, and mean body mass index of 47.9 kg/m(2). The mean operative time was 155 minutes. There were no conversions. The mean body mass index was 39.8 kg/m(2) at 3 months postoperatively (79% follow-up). Complications were few, and included 2 cases of pulmonary embolism (.19%), 3 cases of deep venous thrombosis (.27%), 1 case of gastrojejunal anastomotic leak (.09%), and 9 cases of staple line bleeding (.82%). No patients died. CONCLUSION: RARYGB is safe and effective. Although the operative time might be increased, the complication rates, most notably of anastomotic leak, are extremely low.