Robotic vs Open Mesh Repair

Hernia Discussion Forums Hernia Discussion Robotic vs Open Mesh Repair

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    • #29097
      senleewashington
      Participant

      I (34, male, good shape) have bilateral inguinal hernias that need repaired. My surgeon (Dr. Teruaki Kodama) says he can do either open or robotic surgery and that it’s up to me because the results don’t vary much and he’s comfortable doing either. He has done ~90 open mesh repairs a year over the past 15 years (about 8 per month), versus ~40 robotic repairs a year over the past 2 years (about 3-4 per month). I have an extremely strenuous job with long hours of heavy lifting, and also am very physically active in my time off, so I’m extremely concerned about long-term/chronic pain and recurrence, and fertility complications secondarily. Which option is best for me and my surgeon? Pros and cons? Any further questions I should ask him?

      Notably it’s near impossible for me to get a second opinion or to switch doctors due to my state’s workers compensation.

      Thanks in advance.

    • #29098
      Good intentions
      Participant

      You should just spend time reading the posts on this web forum. Nothing has changed at all over the years since the first post on the site. The materials and methods are the same. There is no special method, or level of skill, that changes the way your body will react to mesh. People that are very physically active seem more susceptible to problems.

      The posts on this site are from real people discussing real experiences. The things that you will find on the medical institution sites and the device maker sites are not focused on the things that you said you are worried about. They will talk about getting back to work quickly, and recurrences, but not chronic pain.

      The decision that you are about to make will probably be one of the most important decisions of your life.

      Here is an abstract from a very recent paper describing the “state-of-the-situation” for mesh implantation. Good luck.

      https://link.springer.com/article/10.1007/s10029-020-02297-1

    • #29107
      senleewashington
      Participant

      That sounds pretty severe! Anything besides mesh is not really an option because of workers comp, which is why I’m just concerned between high-volume open mesh vs mid-volume robotic mesh for my particular case.

    • #29108
      Good intentions
      Participant

      Take your time and do lots of research. You’re worried about money but if you get a bad result money will be meaningless.

    • #29111
      senleewashington
      Participant

      Everything online seems to be conflicting on whether open mesh or robotic mesh is superior in my case.

      I’m not really worried about money. But there are workers comp guidelines in my state that I have to abide by. If I don’t, I get zero coverage and benefits from workers comp, disability, and my own insurance for everything related to the injury forever. So, if I get a bad result within workers comp, I get the bad result, but everything else is taken care of. If I get a bad result outside of workers comp, I lose everything. Additionally, my current surgeon is the best general surgeon in the area, and does more hernia repairs overall than anyone else, even though robotic doesn’t seem to be his specialty. If I were to change doctors, which is not simple, all the other surgeons in my area also only do mesh. So a little cost-benefit analysis easily eliminates the idea of going outside of the workers comp system.

      So, in short, I’m only concerned with open mesh vs robotic mesh repairs.

    • #29113
      Good intentions
      Participant

      I was trying to make you aware of the potential problems with any mesh at all. I am saying “avoid mesh if you can”.

      If you do choose a mesh repair, make sure that you know the details of the material and the method. It is more complex than just “open” or “robotic”. There is a very wide variety of mesh products that can be implanted, and whether or not all are the same or not is not known. Also, ask your surgeon if he does a preventive neurectomy. Some surgeons cut nerves, just-in-case, sometimes leading to problems after surgery.

      Open mesh could be a plug and patch repair which is one of the materials most difficult to work with if there are problems. Open repair could be a Lichtenstein repair. It could be an Onflex repair. It could be a PHS repair. These are all different, but all “open” hernia repair methods.

      Robotic repair is just a form of laparoscopic repair. The same mesh is implanted as a non-robotic laparoscopic repair. So, anything that you read about laparoscopic TAPP repair will apply to robotic repair.

      Sorry. I wish it was as simple as choosing “open” or “robotic”. But it is much more than that. Robotic repair is the “new thing”, there is still much discussion about its true value.

      Most surgeons are going to tell you to just choose a good surgeon and take their advice. Good luck.

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