Editorial

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Journal of Minimally Invasive Surgery 2023; 26(3): 108-109

Published online September 15, 2023

https://doi.org/10.7602/jmis.2023.26.3.108

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

The feasibility of robotic inguinal henia repair in Korea

Sung Il Choi

Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea

Correspondence to : Sung Il Choi
Department of Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
E-mail: drchoi@khu.ac.kr
https://orcid.org/0000-0002-0662-0951

Received: September 4, 2023; Accepted: September 9, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Laparoscopic inguinal hernia repair is a standard surgical procedure in Korea and worldwide. In the early 1990s, laparoscopic surgery with various types of mesh in the preperitoneal space was introduced [1]. The benefits of this minimally invasive surgery include reduced wound complications, shorter hospital stays, less reported pain, and earlier functional recovery [2,3]. Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches are representative procedures of laparoscopic surgery for inguinal hernias and have been endorsed in minimally invasive hernia repairs [4,5].

Despite these advantages and published guidelines, laparoscopic inguinal hernia repair surgeries have plateaued, with the number of cases remaining flat for years [6]. Some surgeons have not adopted laparoscopic inguinal hernia repair as their procedure of choice. Reasons include the learning curve required for the advanced laparoscopic technique and the different surgical anatomy compared to open hernia repairs. The peritoneal closure suture technique is also more difficult in the TAPP procedures.

Robotic technology offers enhanced visualization and superior dexterity and precision, like wristed instruments for performing minimally invasive operations [7]. In Korea, the performance of robotic inguinal hernia repairs began just a few years ago. A relatively small number of patients have been studied, and there is a debate about the feasibility and advantages of robotic inguinal hernia repair. In this article, Jung et al. [8] showed acceptable short-term results in terms of postoperative complications. However, operation times were longer than open or laparoscopic surgery, and no information was gathered about postoperative pain scores, hospital costs, or patient satisfaction [8]. Khoraki et al. [9] published hospital costs comparing laparoscopic versus robotic inguinal hernia surgery. They concluded that the hospital costs of laparoscopic inguinal hernia repairs were significantly higher than those of robotic inguinal hernia repairs. A large prospective randomized study comparing robotic and laparoscopic surgery is needed to determine the feasibility, patients’ satisfaction, surgeons’ satisfaction, safety, and hernia recurrence of both techniques.

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.

  1. Morrell ALG, Morrell Junior AC, Mendes JMF, Morrell AG, Morrell A. Robotic TAPP inguinal hernia repair: lessons learned from 97 cases. Rev Col Bras Cir 2021;48:e20202704.
    Pubmed CrossRef
  2. Pahwa HS, Kumar A, Agarwal P, Agarwal AA. Current trends in laparoscopic groin hernia repair: a review. World J Clin Cases 2015;3:789-792.
    Pubmed KoreaMed CrossRef
  3. Zwols TLR, Slagter N, Veeger NJGM, et al. Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique: a propensity-score-matched analysis in Dutch high-volume regional hospitals. Hernia 2021;25:1265-1270.
    Pubmed KoreaMed CrossRef
  4. Köckerling F, Jacob DA, Lomanto D, Chowbey P. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia. Surg Endosc 2012;26:2394-2395.
    Pubmed CrossRef
  5. Bullen NL, Massey LH, Antoniou SA, Smart NJ, Fortelny RH. Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis. Hernia 2019;23:461-472.
    Pubmed CrossRef
  6. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005;9:1-iv.
    Pubmed CrossRef
  7. Leal Ghezzi T, Campos Corleta O. 30 Years of robotic surgery. World J Surg 2016;40:2550-2557.
    Pubmed CrossRef
  8. Jung S, Lee JH, Lee HS. Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea. J Minim Invasive Surg 2023;26:128-133.
    Pubmed CrossRef
  9. Khoraki J, Gomez PP, Mazzini GS, et al. Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair. Surg Endosc 2020;34:3496-3507.
    Pubmed CrossRef

Article

Editorial

Journal of Minimally Invasive Surgery 2023; 26(3): 108-109

Published online September 15, 2023 https://doi.org/10.7602/jmis.2023.26.3.108

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

The feasibility of robotic inguinal henia repair in Korea

Sung Il Choi

Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea

Correspondence to:Sung Il Choi
Department of Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
E-mail: drchoi@khu.ac.kr
https://orcid.org/0000-0002-0662-0951

Received: September 4, 2023; Accepted: September 9, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

Laparoscopic inguinal hernia repair is a standard surgical procedure in Korea and worldwide. In the early 1990s, laparoscopic surgery with various types of mesh in the preperitoneal space was introduced [1]. The benefits of this minimally invasive surgery include reduced wound complications, shorter hospital stays, less reported pain, and earlier functional recovery [2,3]. Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches are representative procedures of laparoscopic surgery for inguinal hernias and have been endorsed in minimally invasive hernia repairs [4,5].

Despite these advantages and published guidelines, laparoscopic inguinal hernia repair surgeries have plateaued, with the number of cases remaining flat for years [6]. Some surgeons have not adopted laparoscopic inguinal hernia repair as their procedure of choice. Reasons include the learning curve required for the advanced laparoscopic technique and the different surgical anatomy compared to open hernia repairs. The peritoneal closure suture technique is also more difficult in the TAPP procedures.

Robotic technology offers enhanced visualization and superior dexterity and precision, like wristed instruments for performing minimally invasive operations [7]. In Korea, the performance of robotic inguinal hernia repairs began just a few years ago. A relatively small number of patients have been studied, and there is a debate about the feasibility and advantages of robotic inguinal hernia repair. In this article, Jung et al. [8] showed acceptable short-term results in terms of postoperative complications. However, operation times were longer than open or laparoscopic surgery, and no information was gathered about postoperative pain scores, hospital costs, or patient satisfaction [8]. Khoraki et al. [9] published hospital costs comparing laparoscopic versus robotic inguinal hernia surgery. They concluded that the hospital costs of laparoscopic inguinal hernia repairs were significantly higher than those of robotic inguinal hernia repairs. A large prospective randomized study comparing robotic and laparoscopic surgery is needed to determine the feasibility, patients’ satisfaction, surgeons’ satisfaction, safety, and hernia recurrence of both techniques.

Notes

Conflict of interest

The author has no conflicts of interest to declare.

Funding/support

None.

References

  1. Morrell ALG, Morrell Junior AC, Mendes JMF, Morrell AG, Morrell A. Robotic TAPP inguinal hernia repair: lessons learned from 97 cases. Rev Col Bras Cir 2021;48:e20202704.
    Pubmed CrossRef
  2. Pahwa HS, Kumar A, Agarwal P, Agarwal AA. Current trends in laparoscopic groin hernia repair: a review. World J Clin Cases 2015;3:789-792.
    Pubmed KoreaMed CrossRef
  3. Zwols TLR, Slagter N, Veeger NJGM, et al. Transrectus sheath pre-peritoneal (TREPP) procedure versus totally extraperitoneal (TEP) procedure and Lichtenstein technique: a propensity-score-matched analysis in Dutch high-volume regional hospitals. Hernia 2021;25:1265-1270.
    Pubmed KoreaMed CrossRef
  4. Köckerling F, Jacob DA, Lomanto D, Chowbey P. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia. Surg Endosc 2012;26:2394-2395.
    Pubmed CrossRef
  5. Bullen NL, Massey LH, Antoniou SA, Smart NJ, Fortelny RH. Open versus laparoscopic mesh repair of primary unilateral uncomplicated inguinal hernia: a systematic review with meta-analysis and trial sequential analysis. Hernia 2019;23:461-472.
    Pubmed CrossRef
  6. McCormack K, Wake B, Perez J, et al. Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 2005;9:1-iv.
    Pubmed CrossRef
  7. Leal Ghezzi T, Campos Corleta O. 30 Years of robotic surgery. World J Surg 2016;40:2550-2557.
    Pubmed CrossRef
  8. Jung S, Lee JH, Lee HS. Early outcomes of robotic transabdominal preperitoneal inguinal hernia repair: a retrospective single-institution study in Korea. J Minim Invasive Surg 2023;26:128-133.
    Pubmed CrossRef
  9. Khoraki J, Gomez PP, Mazzini GS, et al. Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair. Surg Endosc 2020;34:3496-3507.
    Pubmed CrossRef

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Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248