IS THE FUTURE OF HERNIA REPAIR

Discomfort. Pressure. A new bulge?

A small abdominal wall defect, known as a hernia, may be to blame.

A hernia can occur when there is a weakness or small hole in the fascia, or the lining of the musculature of the abdomen. Fat, intestines or even other organs can protrude through this defect. Over time, if left unaddressed, hernias can become more and more painful and cause significant mobility issues.

Some people are born with hernias, due to a defect in development, while others develop hernias over time due to coughing, strenuous exercises and heavy lifting. Obesity is the most common cause of a worsening hernia.

Common types of hernias include inguinal or groin hernias, where fat or bowels protrude through the muscles of the lower abdomen; hiatal hernias, when the normal opening of the diaphragm expands and the stomach or other organs can protrude into the chest; and ventral hernias, when the hernia pushes through the front of the abdominal wall. Ventral hernias include umbilical hernias, which occur near the belly button, and incisional hernias, which can form when a scar from abdominal surgery weakens over time.

Sometimes, hernias are visible from the outside, appearing as a lump or bulge in the groin, genitals, abdomen or thigh, while other times they are harder to detect because they lie deeper within the body. Symptoms can include discomfort, a feeling of pressure or sharp pain, or changes in the skin over it, especially while exerting yourself or bending over.

Hernias can be treated using multiple surgical techniques. In a traditional “open” hernia repair, the surgeon sutures the hernia defect closed and places a mesh around the repair, generally underneath it. Hernia repair surgery can also be done laparoscopically, where the surgeon uses a laparoscope to repair the hernia with minimal scarring for the patient. Generally, this is performed with tacks and sutures around the mesh, without closing the defect itself.

Hernia repair can also be performed with robotic assistance. This allows closure of the defect, placement of mesh between tissue planes, and improved surgeon comfort and dexterity. This option offers the most flexibility for the surgeon to fix the hernia however is best for the patient’s anatomy.

Robotic-assisted benefits

The robot has two different components. The first is the patient cart, where the arms are contained. From this cart, the surgical team inserts instruments inside the patient, through very small incisions. The second component is the console, where the surgeon sits and can see in 3D with magnification. The surgeon gets full use of his hands and full range of motion, allowing them to perform the equivalent to open surgery through tiny incisions. On the console, hand controls allow the surgeon to manipulate the surgical instruments inside the patient with exact precision and control.

One of the most important benefits of using the robot for surgery is the high-definition 3D capabilities. With the robot, a surgeon can see the anatomy more clearly and have better results. The robotic instruments have more function and movement than human hands, allowing doctors to perform better surgeries. The full extent of the abdomen and its contents can be visualized through one set of incisions.

The benefits of roboticassisted surgery for patients include: The patient resumes their normal activities more quickly than with traditional surgery. Patients say that they have much less pain than expected.

Research also indicates that recurrence of hernias is significantly lower after robotic surgery than with open surgery. Depending on surgeon training and experience, robotic surgery can allow for better mesh repairs than similar hernias that were treated laparoscopically.

The robot can assist in a multitude of general surgery procedures. In addition to hernia repair, we can use robot-assisted surgery to remove gall bladders, perform colon procedures and removal, prevent acid reflux and perform many other surgeries.

For more information, visit McLeodHealth.org.