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Published on March 01, 2017

Robotic Technology Brings New Hernia Repair Modality

Patrick E. McGregor, MD, FACS

Patrick E. McGregor, MD, FACS

Dr. McGregor earned his medical degree from the University of Kansas School of Medicine and completed his residency in general surgery at Creighton University.

Using robotic technology to repair ventral, incisional and inguinal hernias is a novel approach, but it is steadily gaining interest in the field of minimally invasive surgery.

In 2014, use of robotic surgery accounted for less than 5% of all hernia repairs in the United States. “Today, nearly 25% of all hernia repairs are performed with robotic technology,” said Patrick E. McGregor, MD, FACS, a general surgeon with Meritas Health Surgery & Trauma. Dr. McGregor began repairing hernias robotically in March 2016. He has performed 35 such surgeries in the past year and more than 200 robotic surgeries during in his medical career.

Recent studies indicate that robotic technology’s 3-D visualization capabilities, enhanced precision, dexterity abilities, and complete physician control can make the procedure technically easier and possibly reduce complications and post-operative pain.

Expanded Indications

Robotic technology for hernia repair expands the indication to more complex hernias. “Historically, surgeons used the laparoscopic approach only on patients with bilateral hernias because the dissecting balloon divided both sides of the hernia, making the approach too aggressive for a single-sided hernia,” Dr. McGregor explained. With robotic-assisted surgery, Dr. McGregor can address each side separately because he controls the dissection.

Robotic hernia repair also is well-suited for individuals with recurrent hernias. “When you repair a recurrent hernia robotically, you access tissue that hasn’t been disrupted because the previous surgery most likely was done with an anterior approach,” Dr. McGregor said. “The robotic procedure is done posteriorly from behind the abdominal muscle.” Dr. McGregor added that the procedure is viable option for patients who have scarring after a prostatectomy.

Patient-reported Outcomes

Significantly smaller incisions are needed with robotic surgery for inguinal hernia.

Compared to open surgery incisions, significantly smaller incisions
are needed with robotic surgery for inguinal hernia surgery.

Using robotic-assisted technology, Dr. McGregor can repair a hernia defect in a one-hour outpatient procedure while the patient is under general anesthesia. “In my experience, the most significant patient outcome between repairing a hernia robotically versus laparoscopically is the patient’s post-operative pain level,” Dr. McGregor observed.

Postoperative pain often is associated with the penetration of sutures used to adhere the mesh during laparoscopic surgery. Robotic technology allows surgeons to fix the mesh between the peritoneum and the defective area of the abdominal muscle without the need for tacks.

“Placement is so precise, so you don’t need fixation,” Dr. McGregor said. His patients report decreased post-operative pain, less need for pain medication and a quicker return to normal activities. A recent study revealed less time in the recovery room and a decreased level of pain medications were required in the PACU, he added.