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Robotic Surgery for Abdominal Wall Hernia Repair
A Manual of Best Practices
Ricardo Z. Abdalla Thiago Nogueira Costa
Editors
Robotic Surgery for Abdominal Wall Hernia Repair
Ricardo Z. Abdalla • Thiago Nogueira Costa
Editors
Robotic Surgery for Abdominal Wall Hernia Repair
A Manual of Best Practices
Editors
Ricardo Z. Abdalla Department of Gastroenterology University of São Paulo School of Medicine São Paulo, Brazil
Sao Paulo Cancer Institute at University of Sao Paulo São Paulo, Brazil
Thiago Nogueira Costa Department of Gastroenterology University of São Paulo School of Medicine São Paulo, Brazil
Sao Paulo Cancer Institute at University of Sao Paulo São Paulo, Brazil
ISBN 978-3-319-55526-3 ISBN 978-3-319-55527-0 (eBook) DOI 10.1007/978-3-319-55527-0
Library of Congress Control Number: 2017954916
© Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recita­tion, broadcasting, reproduction on microlms or in any other physical way, and transmission or infor­mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica­tion does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword

Surgeons owe it to their patients to optimize their skill sets by staying up to date with emerging hernia repair techniques that may enhance outcomes. Surgeons should avoid thinking that one repair is good for all hernias and instead strive to learn new techniques to broaden the scope of what they can offer patients.
The rise of robotic instruments and platforms to assist in the repair of all types of hernias is upon us, achieving global penetration. Much of this rise in general surgery is secondary to a popular explosion of robotics in hernia repair. A true visionary, Dr. Ricardo Abdalla, performed some of the very rst robotic hernia repairs in the world, and as such he has also started one of the rst robotics programs at his hos­pital. To share what he has learned with the world, he has successfully gathered some of the most pioneering robotic hernia surgeons from various countries to com­pile a comprehensive overview of robotic-assisted hernia repairs and general sur­gery procedures.
This book is essential for any surgeon who wishes to begin or to enhance their robotic hernia experience. From learning how to start a robotic program and training to learning expected short- and long-term outcomes following robotic incisional hernia repairs, Dr. Abdalla’s book successfully teaches how to perform every differ­ent hernia operation.
I have had the privilege of learning directly from Dr. Abdalla, but now through the chapters in this book, all surgeons wishing to embark into the world of robotic surgery can learn from him and his colleagues as well. A true robotic surgeon must have this on his or her shelf!
New York City, NY, USA BrianJacob
v

Preface

“Technology happens, it’s not good, it’s not bad. Is steel good or bad?” It is a question of
when barriers to the adoption of technology will be circumvented not whether it will happen.
Technology itself is morally agnostic. “I think that technologies are morally neutral until we
apply them. It’s only when we use them for good or for evil that they become good or evil.”
Andrew S.Grove, former President and CEO of Intel Corporation (1997)
The abdominal wall is a very wide part of the human body and one of its most prevalent problems are abdominal hernias. Although these conditions are common and taken for granted, they tend to cause major problems in the daily routine of the patient and in their overall treatment.
The main therapy for them is the surgical method, but there is a lack of standard­ization regarding the type of procedure, localization of the problem, size of hernia, classication, and even the approach. With the improving surgical technology novel techniques started to appear and gain space such as laparoscopy. It is very difcult and challenging to consider or understand when a minimally invasive procedure will help, get rid of, or facilitate this problem solution. These procedures are some­times bogged down due to the instruments’ movement limitations, two-dimensional view, and patients’/surgeons’ positioning. There is a long list of restrictions in some procedures that could be cleared as we apply new facilities in diagnosis and prepara­tion to preoperative issues. Robotic technology can overcome these problems in a way that new techniques could be developed and complex hernias could be treated by minimally invasive procedures, which was unthinkable. Fundamentals are the same. The rst step is to be familiar with the robot and its development history. That will change a lot in the near future and we need to be prepared.
However, because robotic surgery has emerged only recently in the hernia eld, there are few standardizations regarding techniques, approaches, and overall setup. Robotic Surgery for Abdominal Wall Hernia Repair intends to be a guide for sur­geons who want to use this evolving method in the treatment of such a prevalent disease. This book is composed mainly of three parts: how to build a robotic hernia center, how to do the procedures, and the other components such as herniosis and technical issues.
In this practical guide we invited experts in robotic hernia repair and surgical leaders to explain the best way to organize a center in all ways, including training, setup, and procedures. The abdominal wall and the trunk were imagined as one
vii
viii
Preface
individualized compartment. We divided the hernias by location and complexity, and each of them is explained step by step by specialists in the area from around the world, using gures and drawings. And most of all, we didn’t forget associated concerns such as quality of life, anesthesia, pain management, meshes, and adhesions.
Surgical practitioners who want to perform in the world with expanding technology have to be guided to facilitate their path and Robotic Surgery for Abdominal Wall Hernia Repair: A Manual of Best Practice is a great way to do so in the hernia eld.
Sao Paulo, Brazil RicardoZ.Abdalla ThiagoNogueiraCosta

Acknowledgments

University of São Paulo Cancer Institute State of São Paulo– ICESP Medical School of the University of São Paulo Ivan Cecconello Ulysses Ribeiro Silvia Kobayashi Evelise Pelegrinelli Zaidan Clinic Engineering of ICESP Springer
ix

Contents

Preparing aRobotic Program andSurgeon Training Regimen
forHernia andAbdominal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ivan Cecconello and Evelise Pelegrinelli Zaidan
Robotic Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Thiago Nogueira Costa
Robotic Repair ofUpper Abdominal Hernias . . . . . . . . . . . . . . . . . . . . . . . 21
Jeremy A. Warren and Alfredo M. Carbonell
Robotic Repair ofLower Abdomen Defects . . . . . . . . . . . . . . . . . . . . . . . . . 35
Eduardo ParraDavila, Flavio Malcher, and Carlos Hartmann
Robotic Ventral Hernia Repair fromaLateral Approach . . . . . . . . . . . . . 49
Conrad Ballecer, Daniela Cocco, and Brian Prebil
Parastomal andLateral Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Ricardo Z. Abdalla, Thiago Nogueira Costa, and Cassio Eduardo Silva Gontijo
Pelvic Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Thiago Nogueira Costa and Ricardo Z. Abdalla
Postoperative Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Pedro Paulo Kimachi and Elaine GomesMartins
Quality ofLife . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Ulysses Ribeiro Jr., Silvia Takanohashi Kobayashi, and Alessandro Gonçalves Campolina
Anatomical Dissection forAdhesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Ricardo Z. Abdalla and Danniel Frade Said
Miscellaneous: Meshes andSutures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Marcelo Furtado
xi
xii
Contents
Molecular Biology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Renato MirandadeMelo
Anesthesia forRobotic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Claudia Marquez Simões
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163