DaVinci Robotic Hernia Surgery

Dr Yunis sitting at the Da Vinci XI Surgical SystemPhysician Assistant Mandy Robotic Surgery

What is Robotic Hernia Surgery?

Inguinal and Ventral Hernia repair is always evolving and improving.

Robotic repair of Inguinal and Ventral Incisional Hernias is the latest most significant step in the evolution of Hernia surgery.

This technology allows the surgeon to operate through 3 or 4 small incisions similar to laparoscopy. 


DaVinci robotic hernia repair advantages :

Ultra high definition 3D vision - better visualization of fine anatomical structures than the human eye alone.  

Surgical instruments that have multiple degrees of freedom allowing for precise movements.

Small incisions minimize risk of wound complications such as infection or wound breakdown.
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How is Robotic Hernia Surgery different from Laparoscopic Hernia Surgery?

Laparoscopic hernia surgery began over 30 years ago. Laparoscopic hernia repair changed things radically by avoiding large incisions and their inherent potential complications. Using 1-inch incisions, the surgeon placed small tubes (known as trocars) into the patient's abdomen. Typically 3 trocars are placed and a camera is placed through one and various instruments ( forceps, scissors, graspers, and needle holders to sew tissue) through the remaining trocars. Typically an assistant would hold the camera and show the operating surgeon the area being worked on. The surgeon is viewing a video monitor and using his or her right and left hands to operate through these small trocars.

Over the last 10 years, laparoscopic hernia repair has evolved into Robotic Hernia repair. One difference is that the camera used is of much higher resolution and sends a 3-dimensional image to the surgeon. This visualization alone is responsible for significant improvement in surgical accuracy and safety. The second difference is that the instruments that pass through the small incisions are significantly improved over laparoscopic instruments. The robotic instruments have multiple points of rotational ability that gives the surgeon the sense their hand is inside of the abdomen.

About Robotic (DaVinci) Hernia Surgery

  • The robot is a tool that allows the surgeon to have improved range of motion and ultra high definition 3D resolution.
  • Three 1/2 inch incisions are created in the abdominal wall and different instruments are passed through them.
  • The surgeon is seated adjacent to the operating room table and controls the camera and instruments with various hand controls and clutches and foot pedals.
  • The surgeon exposes the hernia from the inside of the abdominal wall and creates a space for a customized piece of mesh to be placed behind the muscle and with another layer separating it from the internal organs.
  • Minimal postoperative discomfort
  • Low risk of infection
  • Shorter hospital stay – patients usually discharged within 36 hours.
  • For more information, please review the DaVinci website
DaVinci XI Console
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"The office staff was professional and efficient. Dr. Yunis clearly knows what he’s doing. Top notch operation (pun not intended)."
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The Robotic Hernia Surgery Procedure

surgeon hands on controls articulation
The surgery begins with the surgeon placing small tubes known as "trocars" through these small incisions. The surgical assistant stands next to the patient and can exchange cameras and instruments to be placed through the trocars. The camera and instruments are then attached to the robotic arm system. The surgeon sits at a console where he or she is immersed in a 3D ultra high definition viewer. The instruments placed into the abdominal cavity are controlled by the surgeon using delicate controls managed by finger, hand and foot movements.

Robotic hernia repair often has many advantages over conventional open or laparoscopic hernia repair. Every patient is different and your surgeon will customize the technique for your needs. Sometimes open or laparoscopic techniques are more appropriate for certain people with certain hernias.

Robotic Inguinal Hernia Repair

Robotic Inguinal hernia repair is an advancement in the quality of laparoscopic inguinal hernia repair. Laparoscopic inguinal hernia repair was an entirely new approach to groin hernia repair first appearing in the early 90s. It allowed for repairing the hernia from the inside wall or the pelvis through 3 small abdominal incisions. The placement of mesh behind the hernia defect (posterior repair) allowed for better durability and less pain for inguinal hernia repair.

Now the use of the Intuitive Davinci Robot enables posterior repair with robotic precision. The surgeon's visual resolution is dramatically improved with 3D ultrahigh definition. The surgeon is able to sit down and has much less physical stress than laparoscopy which involves standing and tiring upper extremity movements. Robotic instruments are far more precise and allow for much smoother delicate maneuvers by the surgeon.

Robotic inguinal hernia repair ultimately is a similar, but a more precise technique compared to laparoscopic inguinal hernia repair.

Steps for robotic inguinal hernia repair after the patient is anesthetized with general anesthesia.

  1. Three 8mm cuts are made in the upper abdomen to allow placement of three 8 mm diameter cylinders(trocars).
  2. A camera and two other surgical instruments are placed through these cylinders (trocars)and attached to the robotic arms.
  3. The surgeon is sitting in a type of virtual reality console and is controlling the camera and 2 other instruments. The surgeon's hands are in a delicate controller that translates the surgeon's finger and hand movement to movement of the instruments. The instruments range from different tissue grasping devices to scissors to needle holders (used for sewing).
  4. The innermost layer (peritoneum) is delicately dissected away from the muscular abdominal wall behind the area of the hernia. The surgeon requires experience and skill in order to perform a very delicate and safe dissection. The surgeon is working in an area where many vital structures are adjacent to the area of concern for the hernia repair.
  5. A synthetic mesh (typically polypropylene) is placed behind the area exposed and sutured to certain key but safe locations.
  6. The peritoneum is sewn back to its original location as it covers the mesh within the abdominal wall.

The patient is typically discharged to home within two hours after the surgery. Most surgeons require little if any restrictions of activity during the recovery.

Less than 20% of patients will require prescription pain medicine to control their pain.

Robotic Repair of Ventral Hernia

Robotic ventral hernia repair is a major improvement in outcomes compared with laparoscopic ventral hernia repair. Laparoscopic ventral hernia repair was an entirely new approach to ventral hernias compared with previous open techniques. It became more popular in the early 2000s. It allowed for repairing the hernia from the inside wall of the abdomen through 3 small abdominal incisions. The avoidance of a big incisional scar over the area of repair allows for a much lower risk of infection and wound complications compared to conventional open surgery.

Now the use of the Intuitive Davinci Robot enables ventral hernia repair with superior visibility and robotic precision. The surgeon's visual resolution is dramatically improved with 3D ultrahigh definition inherent in the Intuitive Davinci robotic system. The surgeon is able to sit down and has much less physical stress than laparoscopy which involves standing and tiring upper extremity movements. Robotic instruments are far more precise and allow for much smoother delicate maneuvers by the surgeon.

Robotic technology allows for a much safer exposure of the hernia with a lower risk of injury to the intestine and lower risk of bleeding compared with laparoscopy. One of the biggest problems with laparoscopic ventral hernia repair is the use of multiple tacks in the abdominal wall used to fixate the mesh. Now robotic ventral hernia repair almost eliminates the need for tacks. Using the Davinci robot the surgeon is able to sew the hernia defect closed and sew a mesh to the abdominal wall with less pain than laparoscopy.

There are various techniques used in robotic ventral hernia repair. Regardless of the technique, the robot has been a game changer for patient outcomes. Robotic ventral hernia repair is typically less painful and more durable than previous laparoscopic techniques.

Robotic Umbilical Hernia Repair

Robotic umbilical hernia repair is a major improvement in outcomes compared with laparoscopic umbilical hernia repair. Laparoscopic umbilical hernia repair was an entirely new approach to umbilical hernias compared with previous open techniques. It became more popular in the early 2000s. It allowed for repairing the hernia from the inside wall of the abdomen through 3 small abdominal incisions. The avoidance of a big incisional scar over the area of repair allows for a much lower risk of infection and wound complications compared to conventional open surgery.

Now the use of the Intuitive Davinci Robot enables umbilical hernia repair with superior visibility and robotic precision. The surgeon's visual resolution is dramatically improved with 3D ultrahigh definition inherent in the Intuitive Davinci robotic system. The surgeon is able to sit down and has much less physical stress than laparoscopy which involves standing and tiring upper extremity movements. Robotic instruments are far more precise and allow for much smoother delicate maneuvers by the surgeon.

Robotic technology allows for a much safer exposure of the hernia with a lower risk of injury to the intestine and lower risk of bleeding compared with laparoscopy. One of the biggest problems with laparoscopic umbilical hernia repair is the use of multiple tacks in the abdominal wall used to fixate the mesh. Now robotic umbilical hernia repair almost eliminates the need for tacks. Using the Davinci robot the surgeon is able to sew the hernia defect closed and sew a mesh to the abdominal wall with less pain then laparoscopy.

Robotic umbilical hernia repair is typically less painful and more durable than previous laparoscopic techniques.

Does Insurance Cover Robotic Hernia Surgery?

Widely held insurance plans that cover minimally invasive surgery typically cover robotic hernia surgery.  Robotic surgery for hernia repair is typically covered by insurance, but it is best to check with your insurance plan for details. Learn how we can help you if you don’t have insurance.
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bilateral inguinal hernias - center for hernia repair

FAQs

How long does the DaVinci surgery take?
The length of the DaVinci surgery for hernia repair depends on the complexity of the case but typically lasts 1 to 2 hours.
How long is recovery from robotic hernia surgery?
The recovery time from robotic hernia surgery varies. Most patients can return to normal activities within a few days to a week. Some patients may require several weeks to fully recover. You can learn more about what to expect after hernia surgery here.
Is robotic surgery better for hernia repair?
Robotic surgery for hernia repair offers benefits such as improved visualization and precision, but it is not necessarily better than other surgical techniques. The best method for repair will depend on the individual case and the surgeon's expertise.
Do you have stitches after robotic hernia surgery?
No, the skin is closed with absorbable suture and nothing needs to be removed.
What are the risks of robotic hernia surgery?
The risks are similar to any other operation which includes bleeding, more pain than anticipated, infection, or recurrence of the hernia.
How do you sleep after robotic hernia repair?
There is no specific need to adjust one's sleeping position after robotic hernia repair.
What are the common side effects after robotic hernia surgery?
Common side effects after robotic hernia surgery are similar to any other type of surgery. This includes pain, swelling, and bruising at the incision site.


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