Robotic tissue only repair for a direct hernia?
07/31/2020 at 12:43 am #27720AlephyParticipant
As in the subject, is it possible, or only indirect hernias can be tackled this way? I read somewhere that the robotic approach is also used in non mesh repairs…(for a moment I even thought I had already asked this question, but had problems searching the forum:)
If only for direct hernias, and once in the surgeon realises it is not indirect but direct, do they inevitably go for mesh then?
07/31/2020 at 4:28 am #27721pszotekParticipant
Thanks for the question. Robotic tissue repairs are something newer and Dr. Towfigh just publishes a paper on it. I have been doing them also for a couple years now I’m very select hernias. In most cases I have found it actually easier to do them in direct hernias unless the entire floor blown out. Indirect is also doable but have to be very careful and often the tissue quality is not the best. For patients not wanting traditional mesh and a robotic repair I utilize a reinforced biologic repair on top of the tissue repair with a 95% resorbable product called Ovitex. We have done over 160 of these in the last 24 months with a 1.8% recurrence. This rivals synthetic robotic repair without the issues of concern around the traditional synthetics. In cases like you are describing if the direct is small and has good tissue associated with it we would just do tissue repair. If the floor is blown out up to the inferior epigastric then I usually do a safe tissue repair plus the reinforcement. Hope that helps. Happy to discuss with you anytime through a telehealth visit and show you images of options.
Dr. Paul Szotek
Indiana Hernia Center
07/31/2020 at 7:42 pm #27722UhOh!Participant
Not to hijack this thread, but I’m curious, Dr. Szotek, for a non-robotic tissue repair of a direct hernia, which method do you use for repair? Haven’t made a decision on whether to have mine repaired, but am very curious what options I have within a few hours of Chicago if/when that day comes.
Pretty sure I would prefer tissue repair, and believe mine is a direct hernia.
08/01/2020 at 2:26 pm #27724Good intentionsParticipant
There is no direct mention of chronic pain or discomfort, just “issues of concern”. IF there is solid data showing benefits, it should be shared. If it’s not shared, it’s reasonable to assume that it does not exist. Chronic pain is the #1 concern for a mesh repair.
The “traditional mesh” touts similar recurrence rates. Two years is a very short time frame. The Tela Bio product was introduced through the 510(k) process which does not really require proof of efficacy just similarity to past products. And Dr. Szotek is a consultant for Tela Bio. Also, I am aware of one person in which the Tela Bio resorbable product had to be removed.
These things should all be considered. There is no way to know if the Tela Bio product is a good long-term choice. It’s only real marketing “advantage” is its newness.
From the original post –
“For patients not wanting traditional mesh and a robotic repair I utilize a reinforced biologic repair on top of the tissue repair with a 95% resorbable product called Ovitex. We have done over 160 of these in the last 24 months with a 1.8% recurrence. This rivals synthetic robotic repair without the issues of concern around the traditional synthetics.”
08/01/2020 at 5:39 pm #27725UhOh!Participant
The theory is at least interesting: X amount of mesh is needed to promote healing and tissue growth, but only Y (small fraction of X) is really needed to provide long-term support as a prosthetic.
What I find even more interesting is that Dr. Szotek seems to perform a tissue repair first, theoretically addressing one of the key concerns that led Dr. Kang’s criticisms of mesh (that the defect itself is never repaired).
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