Background: The da Vinci Single Port (SP) robotic platform has great appeal for pediatric surgery. To assess the feasibility, efficacy and identify potential challenges, 11 adolescents underwent SP robotic inguinal herniorrhaphy, and their results were evaluated.
Methods: Patients > 13 years old who presented with an inguinal hernia were offered robotic inguinal hernia repair. We report on the first 11 participants. Through a single 2.5 cm cannula the surgeon controls three fully-wristed, elbowed instruments, and the first fully-wristed da Vinci endoscope. The SP system was used for unilateral and bilateral repair. 2-0 Ethibond sutures were placed extraperitoneally and circumferentially to complete a high ligation of the sac.
Results: All patients were ASA class I or II, outpatients, mean age was 16 years old, mean weight was 77 kg, and 10/11 patients were male. In two cases an unsuspected contralateral hernia was also repaired. There were no fatalities or returns to the operating room. The mean estimated blood loss was 3 ml, and mean case duration was 82 minutes. No patients used immediate postoperative narcotics. One adolescent reported mild constipation and intermittent groin pain, but did not return for repeat follow-up. One patient presented a year later with a direct hernia on the side of the previous repair, and one patient reported a nodule in the incision scar.
Conclusions: SP robotic herniorrhaphy in adolescents appears to be safe and effective. The wristed robotic instruments improve surgeon dexterity. The single incision hidden in the umbilicus improves cosmesis. Patients reported limited pain with prompt return to full activity. Finally, the camera allows identification and repair of bilateral inguinal hernias through a single incision. The cost, procedure duration and long term complications should be further considered, but this series provides an exciting glimpse of what is possible in pediatric robotic surgery.
Keywords: Indirect hernia; Pediatrics; Robotic surgery; Single-port