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ASCENDING THE LEARNING CURVE OF ROBOTIC TRANSVERSUS ABDOMINIS RELEASE (TAR) AND ROBOTIC ABDOMINAL WALL RECONSTRUCTION FOR COMPLEX VENTRAL HERNIA REPAIR: A SINGLE-CENTER EXPERIENCE David Halpern*, Raelina S. Howell, Harika Boinpally, Cristina Magadan-Alvarez, Patrizio Petrone, Collin E. Brathwaite Surgery, NYU Winthrop Hospital, Mineola, NY Background: Robotic complex abdominal wall reconstruction using transversus abdominis release (TAR) has been associated with decreased wound complication rates, morbidity, and length of stay (LOS) compared to open repair in recent studies. This report describes the early experience and short-term outcomes of robotic abdominal wall reconstruction (r-AWR) for complex ventral hernias at a single institution. Methods: A retrospective chart review was performed on all patients undergoing robotic complex abdominal wall reconstruction for abdominal wall defects by a single surgeon from August 2015 to October 2017. Patient characteristics, operative details, and outcomes were assessed. Results: Complex r-AWR was successfully performed in 41 patients. Nine were male (22%), and 32 were female (78%) with a mean age of 60.3 years (range 33-87 years) and a mean BMI of 33.7 (23.4-53.7). Twenty-two patients were current or former smokers (53.7%), 11 patients had diabetes mellitus (26.8%), and 40 patients had ≥1 comorbidity (97.6%). Forty patients had prior abdominal surgery (97.6%). Thirty-three patients presented with an initial ventral hernia (80.5%) and 8 with a recurrent hernia (19.5%). Hernias were classified according to the Ventral Hernia Working Group grading system. Four patients had a grade 1 hernia (9.8%) and 37 patients had a grade 2 (90.2%). Twenty-five patients (61%) underwent posterior component separation with TAR and 16 patients (39%) underwent complex reconstruction with bilateral retrorectus release. Concomitant inguinal hernia repair was performed in 7 patients (17.1%). Mean operative time with TAR was 282.3 minutes (range 106-472) and 177.6 minutes (range 126-254) without TAR. Mean LOS was 1.6 days (range 0-10). Mean follow up was 12.1 weeks (range 1-52 weeks) with no hernia recurrences. Seromas occurred in 5 patients (12.2%), with only one requiring drainage (2.4%). One 30-day readmission (2.4%) occurred following inadvertent drain displacement. There were no conversions to open, 30-day mortalities, or 30-day reoperations. Conclusions: Robotic abdominal wall reconstruction with and without TAR is a safe and feasible procedure that is associated with a short length of stay, low incidence of complications, and low recurrence even within the learning curve experience of the surgeon. The decreased morbidity associated with r-AWR can be especially beneficial for obese patients who have a BMI-dependent increased risk of surgical morbidity, but may not be able to undergo weight loss procedures prior to hernia repair. The decreased LOS and complication rate may make r-AWR a more economical and feasible approach compared to open repair. One would expect the complication rate and operative times to decrease as surgeons gain more experience and move beyond their learning curve.
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