A feasibility report of a novel and unpublished surgical approach for Spiegel's hernia: reconstruction using robotics-assisted surgery
Eduardo H Pirolla,1,2 Felipe Fregni,3 Alexandre L Godoy-Santos,1,4 Vladimir Schraibman5
1Sírio-Libanês Hospital, São Paulo, Brazil; 2Spaulding Rehabilitation Network Research Laboratory, Harvard Medical School, 3Spaulding Rehabilitation Network, Massachusetts General Hospital–Harvard Medical School, Boston, MA, USA; 4Department of Orthopedics and Traumatology, Federal University of São Paulo, São Paulo, Brazil; 5Department of Gastrointestinal Surgery, Federal University of São Paulo, São Paulo, Brazil
Abstract: The Spigelian hernia or Spiegel's hernia is rarely found, with less than 900 cases reported in medical literature. It was first described by J T Klinkosch in 1764 and was named by Adriaan van den Spieghel. The etiology of the hernia may be related to predisposing factors such as weakness of the abdominal wall by the insertion of vascular structures next to the semilunar or arcuate line of Douglas. However, some factors such as obesity, chronic bronchopneumopathies, and pregnancy may be associated with the etiology. Anatomically, most of these hernias occur between the lateral border of the rectus abdominis muscle and the lateral semilunar or Spigelian line that marks the transition of the transversus abdominis muscle to the aponeurosis. Spiegel's hernia can cause serious cases of organ incarceration because its diagnosis is often made at a late stage. Laparoscopic surgery is now an established method for itstreatment. We describe a surgical treatment unprecedented in the literature of Spiegel's hernia with a new procedure: the da Vinci Robotic System. This article also provides in detail the technical advantages and reliability of the robotics-assisted surgical approach on the patient. Robotics-assisted surgical repair for Spiegel's hernia has never been carried out or published previously. The authors show two cases of correction of Spiegel's hernia through surgical robotics, with the use of a mesh-type and double-sided peritoneum suture and the hernia ring suture. Advantages of the robotic approach in relation to laparoscopic technique are highlighted. A systematic review of relevant literature and the history of Spiegel's hernia are reported. The pain score was lower than that reported in pure laparoscopic surgery reports. This may be related to the increased stability of the trocar approach in robotics. It was technically easier to visualize the anterior wall and to suture this site through robotic surgery when compared to the laparoscopic approach. The robotic surgery has proven to be a procedure with significant advantages in terms of intraoperative techniques and postoperative clinical care. However, new cases should be evaluated with a larger follow-up for new conclusions.
Keywords: hernia, robotic, reliability, outcome
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