Inguinal hernias often coexist in prostate cancer patients. They can
sometimes be found on physical exam or during staging CT scans. At the
time of transperitoneal robotic prostatectomy the inguinal areas are examined
with the robotic scope. If hernias exist, they can be fixed at the time of
prostatectomy..
When preoperative CT Scan reveals an inguinal hernia or if I feel one on an
exam, I have my patient see a
laparoscopic general surgeon so the hernia can be fixed at the same time as the robotic
prostatectomy. When the hernias are diagnosed in the operating room, I
call a general surgeon to help me fix the hernia.
In the first 52 robotic prostatectomies I performed, 4 had preoperative
hernias and a general surgeon was available. In another 4 cases (4 of 48
or 9%) I found at least one hernia during the operation. I called a
general surgeon to help fix this. I usually do this robotically while the
general surgeon uses the laparoscopic assistant ports.
The technique is as follows:
1. The hernia is seen on inspection. With the transperitoneal
approach they are obvious. The picture below shows the hook cautery inside
the hernia defect.
2. Instead of opening the peritoneal cavity in a limited fashion just
lateral to the medial umbilical ligaments, I
free up the hernia sac by opening the peritoneum widely over to the anterior
superior iliac spine. I then remove the contents of the hernia including fat
with the robotic instruments.
This is the first half of the robotic hernia repair video.
3. After the robotic prostatectomy is finished we insert a piece of mesh.
Clips are placed into the mesh to anchor it in place. We then place the
peritoneum that was widely opened over the mesh. The video shows us
covering the mesh with anchoring clips.
We have performed 8 of these repairs now, and have changed the closure of the
peritoneum to absorbable suture.
We have not had any complications to date and accept a small chance that
there may be a mesh infection, as with any mesh surgery to fix the hernia at the
same time. The same incisions are used as for the robotic prostate and
this avoids another operation either before or after surgery to fix the hernia.
Click here for
dsl/cable modem feed of a robotic hernia repair.