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Intraoperative complications of robotic-assisted extended totally extraperitoneal (eTEP) ventral hernia retromuscular repairs with mesh: a systematic literature review and narrative synthesis

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Abstract

Minimally invasive extended totally extraperitoneal (eTEP) technique is revolutionising ventral hernia repairs. Robotic-assisted eTEP has been gaining popularity due to better visual clarity and greater dexterity provided by the robotic systems, compared to laparoscopy. Despite growing number of papers being published each year, so far, no study has explored intraoperative complications in robotic-assisted eTEP. The aim was to perform a systematic literature review on the incidence of intraoperative complications in robotic-assisted eTEP ventral hernia repairs. The study protocol was preregistered with PROSPERO, registration number CRD42023450072. Twelve categories of intraoperative complications were defined by the authors. A search of PubMed and Embase was conducted on 16/08/2023, for articles pertaining to robotic-assisted eTEP operations in ventral hernias in adults. Articles were critically appraised and data were extracted using predefined extraction templates. No data were suitable for statistical analysis and a narrative synthesis was performed instead. Ten studies fulfilled the inclusion criteria, of which four studies reported intraoperative complications. Of the 12 categories of intraoperative complications, only 5 were reported. Three studies encountered adherent bowel inside the hernia sac. One reported linea alba injury with subsequent anterior layer dehiscence. There was one case of unrecognised intraoperative retromuscular bleeding and one case of insufflation injury with subcutaneous emphysema. There is a paucity of literature on the incidence of intraoperative complications in robotic-assisted eTEP ventral hernia repairs. Available studies suggest complication rates are low. More robust studies using prospective data from hernia registries are required before further conclusions can be drawn.

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Funding

The first author is a recipient of the Australian Government Research Training Program Scholarship.

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Authors and Affiliations

  1. The University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia, 5011, Australia

    Edward Young, Alex Karatassas & Guy John Maddern

  2. Faculty of Medicine and Health Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia

    Anita Jacombs

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Contributions

All authors contributed to the study conception and design. Literature search, data collection and analysis were performed by EY and AK. The first draft of the manuscript was written by EY and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Edward Young.

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Young, E., Karatassas, A., Jacombs, A. et al. Intraoperative complications of robotic-assisted extended totally extraperitoneal (eTEP) ventral hernia retromuscular repairs with mesh: a systematic literature review and narrative synthesis. J Robotic Surg 18, 58 (2024). https://doi.org/10.1007/s11701-023-01796-4

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