Advanced Robotic Surgery: Transforming Hernia Repair

The muscles of the abdominal wall —the core muscles— wrap in strong layers around the body’s midsection. These vital muscles support the upper body, enable bending and twisting, and help power the arms and legs. They also serve to structurally contain the internal organs.

A hole —or hernia— can occur at or near natural weak points in these core muscles. When a hole forms in the muscle mass, fatty tissue or a portion of an organ may begin to push through that gap, migrating between the abdominal wall and skin and often creating a visible bulge.

A hernia may appear suddenly or gradually over time. Some types are:

• Inguinal hernia, which occurs within the muscles of the groin
• Umbilical hernia, occurring near the navel
• Hiatal hernia, developing within the diaphragm
• Incisional hernia, which can appear at the site of a prior surgery

Depending on size and location, hernias may cause varying levels of discomfort. A small opening that allows some fatty tissue to penetrate may cause no symptoms at all. A larger hole may permit a more substantial portion of internal organ—for example, part of the small or large intestines, bladder, or ovaries—to migrate, triggering pain and other medical issues.

In extreme cases, as an organ is forced through the gap, it can become strangulated—its blood supply so restricted that the organ may begin to die. Most serious cases of hernia warrant medical attention well before they reach this life-threatening stage.

Risk Factors for Hernia

The biggest risk factor for a hernia is simply age. Over decades, it’s normal for muscle tone to diminish and for weakened areas to become increasingly prone to herniation.

In addition, certain medical conditions can encourage hernia development. For example, a serious respiratory condition that causes chronic coughing, such as COPD, can cause recurring force within the belly that results in herniation.

Strenuous activity is also a risk factor—particularly in extreme athletic endeavors, or among weight lifters, or warehouse and construction workers, who routinely lift heavy loads.

Men can be especially susceptible to inguinal hernias due to a small hole that exists naturally within their groin muscles, allowing blood vessels to reach the testicles. The abdominal wall within the inguinal area can weaken with age, also creating the potential for hernia.

As a result of the strain placed on a woman’s abdomen, pregnancy may also create a tear in the abdominal wall; however, the developing baby typically provides a somewhat protective barrier between the tear and a woman’s internal organs.

Among these other risk factors, obesity can also increase the likelihood of hernia, and of its recurrence post-surgery. For this reason, weight loss is often recommended prior to a hernia procedure.

Diagnosing and Treating Hernia

Hernia symptoms can vary, depending on where the hernia is located. For example:

• An abdominal hernia typically appears as a visible bulge that may or may not be painful for the patient.
• In the case of inguinal hernia, one patient may complain of a mass in the groin area that doesn’t hurt at all, while another may experience pain with no visible cause.
• Occurring within the chest, a hiatal hernia often presents as a digestive issue like reflux or as dysphagia—difficulty or discomfort swallowing. Hiatal hernia may decrease respiratory capacity as well.

In order to make a clear and accurate diagnosis of hernia, we conduct a physical examination and review the patient’s medical history, including reports of pain, bulging, or discomfort. If hernia is suspected but is possibly too minimal to detect easily, or if a patient’s abdomen is very large, an ultrasound or CT scan can help confirm the diagnosis.

Once confirmed, surgical treatment of hernia is generally the best course of treatment. This approach has evolved considerably from the days when surgical repair required very large incisions and a complicated healing process. Beginning in the 1980s, laparoscopic—or “belly button”—surgery launched the age of minimally invasive procedures, with reduced incision size making same-day surgery and speedier healing possible.

Today, the game-changer in hernia repair is robotic surgery.

Like laparoscopic procedures, robotic hernia surgery utilizes thin instruments passed into the body via very small incisions, as tiny on-board cameras and lights provide clear views of the area to be repaired. But robotic surgery offers additional advantages over traditional laparoscopy:

• The instruments used for robotic hernia surgery are smaller and even more maneuverable, reducing tissue damage and blood loss and promoting faster recovery. For many patients, smaller incisions mean less post-surgical pain as well.
• The robotic system’s dual cameras deliver a true 3D view, allowing more comprehensive examination of the damaged area.
• As a natural extension of arm and hand movement, surgeons find the robotics console quite intuitive to use. As a pianist, I compare operating the console to playing the piano—it feels instinctive.

Minimally invasive robotics can be used to manage even severe or complex repairs that would have required open surgery just a few years ago. With these tools, we can confidently and effectively repair hernia damage, and tailor and apply a superior grade of supportive mesh to strengthen the affected area.

The vast majority of hernia surgeries are very successful. In just two to three percent of repair procedures, hernia may recur. This may be due to insufficient time allowed for healing or to the patient’s overall health—hernia can sometimes return for smokers (who do not heal as well as non-smokers) and for obese patients.

Recovering from Hernia Surgery

Most patients return home the same day as their hernia surgery. They may experience some soreness for a few days; medication is prescribed when needed, but patients often find that over-the-counter pain relievers are enough to manage their temporary discomfort.

The most critical element of a strong recovery is time allowed for thorough healing.

Most surgical patients can begin a return to light activity within a week or so, when residual soreness from their procedure subsides. Intense core exercises and heavy lifting must be avoided for at least six weeks; however, with their surgeon’s approval, patients can generally take walks, cycle without resistance, and even jog lightly during the six-week recovery period.

Protecting the surgical repair and giving it time to heal, as well as carefully managing weight and tobacco usage, can give the hernia patient their best chance for a complete and healthy recovery.