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Abstract：
OBJECTIVE: Robotic surgery using the da Vinci system has markedly increased worldwide. However, robotic inguinal hernia repair remains unpopular outside the United States. We introduced and evaluated a robotic transabdominal preperitoneal repair (R-TAPP) technique for inguinal hernia in our hospital.
METHODS: First, we designed a task protocol according to the surgical results of 388 laparoscopic TAPP (L-TAPP) procedures performed during the 4 years prior to introducing R-TAPP. Our task protocol included several time limitations during a step-wise procedure: creating the peritoneal flap (<60 minutes), mesh placement with fixation (<30 minutes), and peritoneal suture closure (<30 minutes) under experienced supervision. We investigated the preliminary clinical results of R-TAPP performed by a single operator between December 2018 and January 2020.
RESULTS: We identified 27 lesions in 20 patients (unilateral in 13 and bilateral in seven). According to the Japan Hernia Society Classification, our cohort included eight type I, five type II, and seven bilateral hernias (nine type I, four type II, and one type IV). The median operation time was 124 minutes (range, 81-164 minutes), and the median console operation time was 85 minutes (range, 50-132). The median time required for the peritoneal incision was 30 minutes (range, 18-54 minutes), that for mesh placement (including tucking) was 13 minutes (range, 7-27 minutes), and that for peritoneal suturing was 9 minutes (range, 3-20 minutes).
CONCLUSIONS: Our preliminary results suggest that our task protocol for R-TAPP is feasible. However, refinement of our task protocol is essential for standardization.
METHODS: First, we designed a task protocol according to the surgical results of 388 laparoscopic TAPP (L-TAPP) procedures performed during the 4 years prior to introducing R-TAPP. Our task protocol included several time limitations during a step-wise procedure: creating the peritoneal flap (<60 minutes), mesh placement with fixation (<30 minutes), and peritoneal suture closure (<30 minutes) under experienced supervision. We investigated the preliminary clinical results of R-TAPP performed by a single operator between December 2018 and January 2020.
RESULTS: We identified 27 lesions in 20 patients (unilateral in 13 and bilateral in seven). According to the Japan Hernia Society Classification, our cohort included eight type I, five type II, and seven bilateral hernias (nine type I, four type II, and one type IV). The median operation time was 124 minutes (range, 81-164 minutes), and the median console operation time was 85 minutes (range, 50-132). The median time required for the peritoneal incision was 30 minutes (range, 18-54 minutes), that for mesh placement (including tucking) was 13 minutes (range, 7-27 minutes), and that for peritoneal suturing was 9 minutes (range, 3-20 minutes).
CONCLUSIONS: Our preliminary results suggest that our task protocol for R-TAPP is feasible. However, refinement of our task protocol is essential for standardization.
摘要：
目的：使用达芬奇系统的机器人手术在全球范围内显著增加。然而,机器人腹股沟疝修补术在美国以外仍然不受欢迎。我们介绍并评估了我院腹股沟疝的机器人经腹腹膜前修补术（R-TAPP）技术。
方法：首先，我们根据引入R-TAPP前4年内进行的388例腹腔镜TAPP(L-TAPP)手术的手术结果设计了任务方案.我们的任务方案包括在逐步程序中的几个时间限制：创建腹膜瓣（<60分钟），固定网片放置（<30分钟），在有经验的监督下进行腹膜缝合（<30分钟）。我们调查了2018年12月至2020年1月由一名操作者进行的R-TAPP的初步临床结果。
结果：我们在20例患者中发现了27个病灶（13例单侧，7例双侧）。根据日本疝学会分类，我们的队列包括8个I型，五类II，和七个双侧疝（九种I型，四种II型，和一种类型IV）。中位手术时间为124分钟(范围，81-164分钟），控制台操作时间中位数为85分钟(范围，50-132).腹膜切口所需的中位时间为30分钟（范围，18-54分钟），网格放置(包括打褶)为13分钟(范围，7-27分钟），腹膜缝合是9分钟(范围，3-20分钟）。
结论：我们的初步结果表明，我们的R-TAPP任务方案是可行的。然而,完善我们的任务协议对于标准化至关重要。
方法：首先，我们根据引入R-TAPP前4年内进行的388例腹腔镜TAPP(L-TAPP)手术的手术结果设计了任务方案.我们的任务方案包括在逐步程序中的几个时间限制：创建腹膜瓣（<60分钟），固定网片放置（<30分钟），在有经验的监督下进行腹膜缝合（<30分钟）。我们调查了2018年12月至2020年1月由一名操作者进行的R-TAPP的初步临床结果。
结果：我们在20例患者中发现了27个病灶（13例单侧，7例双侧）。根据日本疝学会分类，我们的队列包括8个I型，五类II，和七个双侧疝（九种I型，四种II型，和一种类型IV）。中位手术时间为124分钟(范围，81-164分钟），控制台操作时间中位数为85分钟(范围，50-132).腹膜切口所需的中位时间为30分钟（范围，18-54分钟），网格放置(包括打褶)为13分钟(范围，7-27分钟），腹膜缝合是9分钟(范围，3-20分钟）。
结论：我们的初步结果表明，我们的R-TAPP任务方案是可行的。然而,完善我们的任务协议对于标准化至关重要。
