The Why and What of Robotic Surgery for Hernias

Hernia surgery is one of the most common non-urgent surgeries in the United States, with about a million people a year undergoing a repair. Many people put off having it because they don't want to take time off from work or be burdened by recovery restrictions for weeks afterward. But today's surgical technology is changing that – consider robotic hernia surgery as an option. Dr. Jared Brooks and Dr. Gregory Kim with Sentara Surgical Specialists explain why.

"Hernia repairs traditionally get fixed through a long abdominal incision, with open procedure. But using robotic tools, we can repair defects and place mesh in layers of the wall rather than inside of the abdominal cavity, which makes the process less invasive, and speeds recovery time," said Dr. Brooks.

Hernias: What and Why?

First, what is a hernia? There are a number of different types, but the basic definition is when an internal part of the body (fat, intestines or muscles) pushes through the muscles of the abdominal wall.

Second, why does it need to be repaired? It needs to be repaired because the hole it pushes through may restrict blood flow to the intestine trapped in the bulge. Over time, the hernia will not repair itself, it will only get bigger. The mesh that's inserted strengthens the area near the original hole and prevents future hernias.

Many people do not realize they have a hernia, and often find out when they have pain from it, or it's discovered on an image, such as a CT scan, possibly while diagnosing a different issue. There is growing evidence that while some hernias are caused by mechanical issues, such as lifting something too heavy, many are genetically linked. If someone in your family has had a hernia, you may be at risk as well.

"Wherever there is inherent weakness in the body, things will push through. If you are lifting something, it can create a balloon effect and push into the area of least resistance," Dr. Kim said.

Dr. Kim also notes that being overweight can also lead to a hernia due to additional stress on the abdominal wall.

"I like to call this the 'battle of the bulge' because that's what a hernia is – something sticking out where it shouldn't be. Many people don't understand the anatomy of their torso, but the muscular layers of the abdominal walls help support all of the internal organs and it's important to keep everything functioning properly," said Dr. Brooks.

Types of Hernia Repair

The most common types of hernias are inguinal (in the groin), hiatal (in the diaphragm) and umbilicus (in the belly button.) The robotic techniques are part of a surgical evolution from open surgery (where an incision is made over the area to be repaired) to laparoscopic repair (where small incisions are made and a flexible camera tube provides the view inside the body). Robotic surgery allows more range of movement for the surgeon – like a rotating wrist rather than chopsticks.

"The surgeon's training and tools can make a big difference for the patient. I can lay mesh from the inside – kind of like patching a tire from the inside – which will make it more precise and strengthen the repair. Robotic repair has a lot of advantages for hernia patients," said Dr. Brooks.

Why Robotic?

The difference is that the patch is sandwiched between the abdominal wall and the fascia rather than tacking, which is what happens during laparoscopic procedures. There's less pain without the sutures, which means shorter hospitalization time. Dr. Brooks said that studies of robotic hernia repairs show evidence that there's a low risk of recurrence and complication from placement of mesh as well.

"Robotic surgery is superior because it allows for more dexterity and the ability for the surgeon to do it. The process is easier to sew the fascia on the inside without a large cut and without sticking tacks through the muscle," said Dr. Kim. "It's not just a fancy sewing machine, I think that there will be a lot more robotic surgeries and more uses. This is what innovation looks like – less pain, less complications, less need for narcotics."

Dr. Kim will be operating at the new robotic suite at Sentara CarePlex Hospital in Hampton, while Dr. Brooks operates at Sentara Leigh Hospital in Norfolk.

So for people who suspect they have hernia, or who have a ventral (front side of the body) hernia, this option may offer the incentive they need to get it repaired. Robotic hernia surgery is minimally invasive, and many people can recover in a week or two instead of four to six weeks.