[Application of Da Vinci robotic surgery to hernia repair].

摘要

Da Vinci robotic surgical system has brought giant evolution to minimally invasive surgery, and also improved the development of hernia surgery. Recently, Da Vinci robotic surgical system has been successfully applied to the repair of incisional hernia, inguinal hernia, and esophageal hiatal hernia. In the area of incisional herniorrhaphy, endowrist with 7 degrees of freedom, high definition and naked eye 3D imaging system can make Da Vinci robotic surgical system easy to complete the subtle suture in the anterior abdominal wall from the abdominal cavity. As a result, transabdominal preperitoneal repair(TAPP), intraperitoneal onlay mesh(IPOM) or the posterior components separation techniques (pCST) can be easily accomplished. In the repair of esophageal hiatus hernia, the high definition field and flexible machine wrist of the Da Vinci robotic surgical system also make the identification of nerve and artery more accurate, and the local suture more easy, and the prosthetic placement and fixation more reliable. However, in the field of inguinal hernia repair, the traditional 2D laparoscopic technology is able to provide patients with sufficient minimally invasive advantages, and Da Vinci robotic surgical system does not have obvious advantage because of its expensive cost. Previous small-sample and retrospective studies showed that Da Vinci robotic hernia repair was safe and effective, and had more fineness and dexterity than conventional laparoscopic hernia repair. However, large-sample prospective randomized control trials are still absent for short- and long-term evaluation of Da Vinci robotic hernia repair. With the accumulation of robotic hernia repair cases, the increase of surgical experience, and the development of clinical trials, Da Vinci robotic surgical system will play more important role in hernia repair.