Robotic Hernia Surgery

What is robotic hernia surgery (robotic hernia repair surgery)?

Robotic hernia surgery is a type of surgery that uses small cuts to treat hernias. A hernia is when an organ pushes through the muscle or tissue wall that contains it. Robotic hernia surgery puts the herniated organ back where it belongs and closes the muscles where the organs are pushing through, so you have a strong barrier.

Robotic hernia surgery is sometimes called robotic-assisted laparoscopy. Unlike open surgery, which involves one large incision (cut), laparoscopic surgery and robotic surgery allow your surgeon to operate using a few small cuts. They insert a tiny scope with a camera that allows them to see your organs on a screen while they repair your hernia through the incisions. Fewer cuts usually mean less bleeding, less pain and a shorter recovery time.

During a robotic hernia, your surgeon controls the robotic arms and instruments from a screen that’s next to you. This technology allows your surgeon to make precise movements and repair difficult or complex hernias with small cuts rather than a large incision.

What conditions does robotic hernia surgery treat?

Robotic surgery can repair smaller hernias or rebuild your entire abdominal wall. Common types of hernias robotic hernia surgery treats include:

• Inguinal hernias: Tissue in your abdomen (like belly fat or part of your intestines) pokes through your abdominal wall in an area called the inguinal canal. This is in your groin area.
• Femoral hernia: Tissue in your abdomen pokes through your abdominal wall into an area called the femoral canal. It’s located just underneath the inguinal canal.
• Hiatal hernia: The top of your stomach pokes through the opening in your diaphragm and into your chest wall.
• Incisional hernia: An organ or tissue pokes through an incision where you previously had surgery.
• Umbilical hernias: Part of your intestine pokes through your abdominal wall near your belly button.

Other types of hernias that may involve robotic surgery include:

• Flank hernias: Hernias off to the side of your abdomen.
• Epigastric hernias: Hernias above your belly button.
• Congenital diaphragm hernias: Hernias in the diaphragm that some people are born with.
• Lumbar hernias: Hernias in your back.

How common is robotic hernia repair surgery?

Traditionally, surgeons use open surgery to repair hernias. But as surgical technology improves, more surgeons are choosing laparoscopic or robotic approaches. Robotic hernia repair surgery is still new. Its first reported use in humans was in 2007.

Since then, robotic hernia repair surgery has become more popular as surgeons have learned more and become more familiar with the technology’s potential benefits.

How should I prepare for this procedure?

You’ll work with your surgeon to ensure you’re a good candidate for robotic hernia surgery. Laparoscopic or robotic surgery isn’t always the best option for your specific hernia. It depends on your unique case. Your surgeon will consider multiple factors, including:

• The size of your hernia.
• How complex the repair will be.
• Whether this is your first hernia surgery or if it’s to repair a hernia that’s returned.
• How well you tolerate anesthesia (laparoscopy usually requires general anesthesia).
• If you need to have any scars or excess skin removed at the same time as hernia surgery.

Your surgeon may also discuss available options if they find an occult (or hidden) hernia during surgery. These hernias don’t show up during exams or ultrasounds, but your provider may find one while repairing your diagnosed hernia. According to research, surgeons find occult hernias in 16% of robotic inguinal hernia repairs.

It’s important to have a plan in place in case your surgeon finds this type of hernia during surgery.

What happens during robotic hernia repair surgery?

You may need to pee first so your bladder’s empty. Or you may need a Foley catheter to collect your urine during the repair.

During the procedure, a surgeon sits at a console near your bedside that allows them to control the surgical instruments (robot) they use to operate.

The specific steps vary, but surgery generally goes like this:

1. You’ll receive general anesthesia to put you to sleep so you don’t feel any pain during surgery.
2. Your surgeon will make a few (usually three or four) incisions. They’ll insert a thin, telescope-like instrument called a laparoscope into one of your incisions. The laparoscope connects to a video camera (smaller than a dime) that projects a detailed, three-dimensional view of your insides onto screens in the operating room.
3. Your surgeon will inflate your abdomen with a harmless gas (carbon dioxide), making it easier for them to see the internal structures they need to operate on.
4. Your surgeon will maneuver the robot to repair your hernia. Repair may involve stitching tissue together and using mesh to reinforce the tissue.
5. Once the repair is complete, your surgeon will close your incisions with sutures or staples.

What is the average time for robotic hernia repair?

Surgery time depends on how complex the repair is. Simple procedures may be as short as 30 minutes. More complex procedures may take five hours or longer.

Some studies suggest that, on average, robotic hernia repair takes longer than laparoscopic repair without a robot or open surgery.

What should I expect after robotic hernia surgery?

You’ll wake in a recovery room, likely feeling groggy from the anesthesia. You may notice bruising and swelling at the incision sites. This is normal. Your care team will work with you to assess your pain. Most people need to take NSAIDs to help with the pain.

It typically takes an hour or two to feel well enough to go home. Most people go home the same day of their surgery, but you may need to stay in the hospital overnight if your surgery is more complex.

Plan to have someone drive you home, and take it easy for the first 24 hours.

What are the benefits of robotic hernia repair surgery?

There are several potential advantages of robotic surgery over laparoscopic. One of the biggest differences between laparoscopic surgery and robotic surgery is that robotics technology provides three-dimensional (3D) images of the inside of your abdomen. Laparoscopic surgery provides two-dimensional images. The more detailed, 3D images create a clearer picture for your surgeon to reference as they operate.

Other benefits of robotic hernia surgery include:

• Under your surgeon’s direction, the robot can move more freely and with more versatility than a human hand.
• You’ll have a few tiny scars rather than one large incision scar (as with open surgery).
• You’ll likely experience less pain after this surgery compared to open surgery.
• You’ll likely have a quicker recovery time than with open surgery.

What are the risks or complications of robotic hernia repair surgery?

Robotic hernia repair surgery, like laparoscopic surgery, is generally considered a safe, minimally invasive procedure. Still, all surgeries come with potential risks. Risks or complications for robotic hernia repair surgery include:

• Bleeding.
• Pain during sex.
• Reaction to the anesthesia.
• Seromas (collection of fluid).
• Hematomas (collection of blood).
• Injury to nearby tissue, organs or blood vessels.
• Infection at the incision site or where the repair was made.
• Problems emptying your bladder (you may need a catheter in the short term to help).

It’s also possible that the hernia returns.

While it’s normal to experience mild to moderate pain following hernia surgery, it usually resolves within a few weeks to months. Pain that persists long-term (usually considered pain that lasts longer than three months) is often considered chronic pain after hernia repair. If you’re diagnosed with this condition, you may need medications or surgery to address it.

What is the recovery time for robotic hernia surgery?

Recovery time depends on how extensive your repair was. Activity restrictions vary widely based on hernia repair and surgeon. Sometimes, there aren’t any restrictions after robotic hernia repairs. Other times, surgeons recommend activity restrictions for two to four weeks after surgery. Your surgeon will advise you on what your recovery timeline will look like and what activities to avoid.

In the meantime, communicate with your healthcare provider about your pain. They can prescribe medications that can help with pain while you’re healing.

When can I go back to work/school?

Most people can return to work or school within several days of surgery. Your timeline depends on your job type (for example, if you do a lot of heavy lifting), the type/size of your hernia and how much pain you’re experiencing.

People who have robotic hernia repair surgery can usually return to their normal activities more quickly and with less pain medicine than those who have open surgery.

When should I call my healthcare provider?

Call your healthcare provider if you notice any signs of a complication following surgery, including:

• Fever and chills.
• Inability to poop or pass gas.
• Pus draining from the incision.
• Pain, redness, warmth or swelling at the incision site.
• Blood seeping through your bandage.

Go to the ER if you notice signs of a blood clot in your leg (deep vein thrombosis). Signs include:

• Pain in your leg (including your calf, behind your knee and thigh) or groin.
• Sudden swelling, warmth or redness in your leg or groin.

Is robotic surgery best for hernia?

It depends. Robotic surgery provides benefits similar to laparoscopic surgery. These include smaller incisions, fewer scars and less bleeding. You may also experience less pain and a faster recovery time compared to an open surgery for a similar hernia.

Whether you receive laparoscopic surgery or robotic-assisted laparoscopic surgery depends on various factors — including whether the hospital has the technology, how skilled the surgeon is with the technology, and other specifics with the hernia itself (size, location, previous repairs, need for skin excision).

Some types of hernias still require open surgery. Ask your healthcare provider which type of surgery they recommend for you. Discuss the benefits of robotic surgery with your surgeon over other types, and make sure you’re comfortable with the final decision.