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Robotic Hernia Repair

What is a Hernia?

A hernia is a broad term that refers to a bulge or protrusion of an organ/tissue through the tissue that usually contains it in its normal anatomical place. Most commonly this is a weakness in the muscle/fascia of the body. This area of weakness then allows organs like the intestines to push through the hole, and cause the herniation.

Symptoms of a Hernia

Symptoms and signs differ depending on the kind of hernia. A lot of times the herniated tissue moves back and forth through the weakness with minimal symptoms. Sometimes you will see a bulging in this area. Symptoms include pain, swelling, pressure. If the hernia gets stuck in the bulge, this is called an “incarceration.” This will produce more pain and can lead to “strangulation” (death of the tissue). This is a serious problem if the tissue is an organ like intestines or colon.

Common types of Hernias

There are many different types and sizes of hernias. Examples include Inguinal hernia ( In the groin region), Incisional hernia (Site of previous abdominal surgery) or Hiatal hernia (Upper Stomach, diaphragm).

  • Epigastric (midline of the upper abdomen)
  • Hiatal (upper stomach, diaphragm)
  • Inguinal (inner groin)
  • Femoral (outer groin)
  • Incisional (near a scar of previous surgery)
  • Umbilicus (at the stomach button.)
  • Ventral hernia
  • Spigelian

An inguinal (groin) hernia happens when the intestine, for example, protrudes through the weak spot in the abdominal muscles at the inguinal canal. Inguinal hernias are more common in men and about 1 in 4 men will develop one in life. There are two kinds of Inguinal hernias:

Indirect Inguinal (groin) hernia is when the internal inguinal canal which should close by the time of birth remains open. This hernia is usually diagnosed in the first year of life.

Direct Inguinal (groin) hernia is when part of the intestine pushes through a weak abdominal muscle by the wall of the inguinal canal. This type occurs in male adults.

Incisional hernia is when part of an organ or tissue bulges through a weakness in the abdominal wall at the site of previous abdominal surgery. This is a common risk/side effect of having abdominal surgery. After surgery the muscle/fascia that is stitched becomes weak. The peritoneum (covering of the abdominal hole) protrudes through, and the defect causes bulging. The bulging is more evident when the abdominal muscles are straining. Any actions that increase intra-abdominal strain may worsen the hernia; examples of such activities are lifting, coughing, or even straining to pee or a bowel movement.

The hiatal hernia occurs when a weak muscle tissue allows the stomach to bulge through the diaphragm. This may result in gastroesophageal reflux illness (GERD) or laryngopharyngeal reflux (LPR). Symptoms of Hiatal hernia are:

  • Shortness of breath (induced by the hernia’s force on the membrane)
  • Heartburn
  • Backflow of stomach acid into the esophagus (acid reflux).
  • Chest pain

There are many different types and sizes of hernias. In general, hernias can lead to organs or other structures moving through the weak tissue into an area they should not be. This can lead to pain/discomfort and more serious complications such as bowel blockages or compromised organs.

Who typically gets Hernias?

Men are more prone to develop hernias more often than females because of their anatomy and higher personal exertions. Smokers are also very likely to develop hernias because of the increased coughing, which increases the pressure in the abdominal wall.

I think I have a Hernia

If you think you have a hernia it is best to be examined by your primary care physician or surgeon. This will help determine the type of hernia, the size and if surgical repair needs to be undertaken. Sometimes we do imaging studies such as CT Scans to help identify the location and size of the hernia. This is important for Operative planning.

The only way to repair a hernia is through surgery.

Robotic Surgical Hernia Repair

When your doctor tells you that you need surgery to repair your hernia, many thoughts and concerns fill your mind. Will the operation be a success? How painful will it be, how much time off from work do I need?

Hernia repair surgery requires returning the organ to its place and repairing the tears in the surrounding tissue.

The good news is that surgical techniques have greatly advanced. We now have new procedures and materials which offer options that can decrease discomfort and speed recovery and help you get back to your life faster.

The principles of hernia repair include 2 main parts to the operation

  1. Close the weak tissue by stitching them together
  2. Place a mesh (Synthetic material) which reinforces the repaired tissue and acts as the new muscle/fascia to prevent herniation.

The robotic techniques used by ATX Robotic Surgeons are part of the surgical evolution from open surgery. In traditional open surgery, an incision is made over this site of the hernia and the hernia is repaired with mesh. This requires big incisions which leads to more pain, longer time off work, longer time away from life activities and sometimes even days in the hospital. This also leads to additional use narcotic pain medication.

Minimally invasive surgery can be done laparoscopically or with the robotic surgery system. In laparoscopic surgery small incisions are made and a mesh is placed to recreate the weakness. In traditional laparoscopic surgery it is difficult to stitch the weak tissue together due to limitations of the instruments and camera. Usually only a mesh is placed to repair the hernia. This only applies 1 of the principles of hernia surgery.

Robotic surgery has made hernia repairs easier, faster and with less blood loss and more precise stitching.

One of the most significant differences between a laparoscopic operation and robotic surgery is that the robotic instruments offer the ATX Surgeon a more extensive range of motion. The robotic instruments can move in ways that the human hand cannot. The superior 3D visualization with 4K high definition allows for precise dissection of tissues and suturing.

This allows the surgeon to repair the hernia with stitches and then place the mesh for reinforcement. This achieves both principles of hernia repair. The surgeon can also fix more complex and larger hernias using the robotic technique.

It is essential to know that your ATX Surgeon is in complete control during the entire surgical procedure; the robotic system responds to the directions your surgeon provides with precise movements inside your body.

Recovering from a Hernia

After Robotic hernia surgery there is still at least 2-4 weeks that there are activity restrictions. This includes no lifting more than 15LBS. No running, jumping or straining. Most patients can get back to all normal activities and working within several days after surgery.

Post-operative restrictions vary between patients and type/size of hernia. Patients will be given specific instructions based on their operation.

Thanks to innovations in robotic engineering, surgeons can do hernia repair operations through small incisions rather than the larger incisions associated with conventional open surgery; this results in less harm to surrounding tissues, less pain for the patient, less risk of infection, less blood loss and a faster recovery. Patients are also able to have more outpatient surgery(can go home the day of surgery) and less days in the hospital after major hernia repairs.

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ATX Robotic Surgery serves the Austin and the Central Texas Area.

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