Structured Resident Training in Robotic Surgery: Recommendations of the Robotic Surgery Education Working Group.

Objective: A universal resident robotic surgery training pathway that maximizes proficiency and safety has not been defined by a consensus of surgical educators or by surgical societies. The objective of the Robotic Surgery Education Working Group was to develop a universal curriculum pathway and leverage digital tools to support resident education.

Design: The two lead authors (JP and YN) contacted potential members of the Working Group.

Current practices in complex abdominal wall reconstruction in the Americas: need for national guidelines?

Background: Component separation (CS) procedures have become an important part of surgeons' armamentarium. However, the exact criteria for training, procedure/mesh choice, as well as patient selection for CS remains undefined. Herein we aimed to identify trends in CS utilization between various cohorts of practicing surgeons.

Simulation in Hernia Surgery: Where Do We Stand?

Simulation seems to be the best method of improving medical attitude, technical skills, and operating times. A literature review of the available data in simulation for hernia surgery was performed. Surgical simulation has been included as a main requirement in residency programs and endorsed by several surgical societies.

Robotic-Assisted Transabdominal Preperitoneal Ventral Hernia Repair.

Ventral hernia repair is one of the most common operations performed by surgeons worldwide. The widespread adoption of laparoscopic surgery has significantly reduced complications related to traditional open approaches. The most common approach in laparoscopic ventral hernia repair is the intraperitoneal onlay mesh (IPOM) approach.

Evaluation of anterior versus posterior component separation for hernia repair in a cadaveric model.

Background: Component separation remains an integral step during ventral hernia repair. Although a multitude of techniques are described, anterior component separation (ACS) via external oblique release (EOR) and posterior component separation (PCS) via transversus abdominis muscle release (TAR) are commonly utilized. The extent of myofascial medialization after ACS or PCS has not been well elucidated.

Laparoscopic ventral hernia repair with and without defect closure: comparative analysis of a single-institution experience with 783 patients.

Background: Laparoscopic ventral hernia repair (LVHR) has gained popularity, since it can decrease the incidence of surgical site complications while providing similar recurrence rates as open repairs. The role of defect closure in LVHR has been a subject of controversy and has not been fully elucidated. We aimed to compare outcomes of LVHR with and without defect closure in a contemporary cohort.

Stapled Transabdominal Ostomy Reinforcement with retromuscular mesh (STORRM): Technical details and early outcomes of a novel approach for retromuscular repair of parastomal hernias.

Background: Parastomal hernia repair (PHR) remains a challenge with no optimal repair technique. During retromuscular hernia repair, traversing the stomal conduit through the abdominal wall can result in angulation and compression. Widening of traditional cruciate incisions in mesh and/or fascia likely contributes to recurrences.

Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release.

Background: Transversus abdominis release (TAR) has evolved as an effective approach to complex abdominal wall reconstructions. Although the role of robotics in hernia surgery is rapidly expanding, the benefits of a robotic approach for abdominal wall reconstruction have not been established well. We aimed to compare the impact of the application of robotics to the TAR procedure on the perioperative outcomes when compared to the open TAR repairs.

Hiatal Hernia Repair: Current Evidence for Use of Absorbable Mesh to Reinforce Hiatal Closure.

Introduction: There continues to be debate regarding the best surgical technique for the treatment of paraesophageal hernias. While laparoscopic and robotic approaches are widely employed around the world, the benefits of mesh use to reinforce hiatal closure are still not well established. The goal of this manuscript is to describe the currently available results with biologic and bioabsorbable meshes for treatment of paraesophageal hernias, particularly with reference to the rate of recurrence.

Is old age a contraindication to elective ventral hernia repair?

Background: Ventral hernia repair (VHR) is a frequent problem in the expanding aging population. However, advanced age is often viewed as a contraindication to elective hernia surgery. We aimed to analyze outcomes of VHR in a large cohort of elderly patients.

Evaluation of antibiotic pressurized pulse lavage for contaminated retromuscular abdominal wall reconstruction.

Background: Despite patient risk factors such as diabetes and obesity, contamination during surgery remains a significant cause of infections and subsequent wound morbidity. Pressurized pulse lavage (PPL) has been utilized as a method to reduce bacterial bioburden with promising results in many fields. Although existing methods of lavage have been utilized during abdominal operations, no studies have examined the use of PPL during complex hernia repair.

Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh.

Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction.

Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs.

Background: Contaminated operative fields pose significant challenges for surgeons performing ventral hernia repair. Although biologic meshes have been utilized increasingly in these fields, recent evidence suggests that synthetic meshes represent a viable option. We analyzed the outcomes of biologic and synthetic mesh utilized in patients undergoing major ventral hernia repair in clean-contaminated/contaminated fields.

Evaluation of the Antimicrobial Efficacy of a Novel Rifampin/Minocycline-Coated, Noncrosslinked Porcine Acellular Dermal Matrix Compared With Uncoated Scaffolds for Soft Tissue Repair.

Background Despite meticulous aseptic technique and systemic antibiotics, bacterial colonization of mesh remains a critical issue in hernia repair. A novel minocycline/rifampin tyrosine-coated, noncrosslinked porcine acellular dermal matrix (XenMatrix AB) was developed to protect the device from microbial colonization for up to 7 days. The objective of this study was to evaluate the in vitro and in vivo antimicrobial efficacy of this device against clinically isolated methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli.

Development of a novel murine model for treatment of infected mesh scenarios.

Background: Indications regarding hernia repair after removal of previously infected prostheses remain unclear. Patients may receive staged primary repair or single-stage reconstructions, neither of which may be ideal. Although animal models have simulated contamination by direct inoculation of implants with bacteria, there remains a paucity of literature, which simulates a field following mesh infection and removal.

Outcomes of Retromuscular Porcine Biologic Mesh Repairs Using Transversus Abdominis Release Reconstruction.

Background: Optimal mesh reinforcement and operative technique for major abdominal wall reconstructions (AWR) remain debatable. Posterior component separation via transversus abdominis release (TAR) allows for wide sublay mesh reinforcement with durable reconstruction, and has been gaining popularity in recent years. Although biologic mesh has been associated with mixed results, outcomes of AWR with bioprosthetics have not been well elucidated to date.

Outcomes of Retromuscular Approach for Abdominal Wall Reconstruction in Patients with Inflammatory Bowel Disease.

Ventral hernia repair (VHR) in patients with inflammatory bowel disease (IBD) presents unique surgical challenges including impaired wound healing, concomitant intestinal operations, along with likely future abdominal surgeries. Appropriate techniques and mesh choices in these patients remain under active debate. Herein we report our experience with using a retromuscular approach for major VHR in a consecutive cohort of IBD patients.

Efficacy of transversus abdominis plane block with liposomal bupivacaine during open abdominal wall reconstruction.

Background: Transversus abdominis plane block (TAPb) is an analgesic adjunct used for abdominal surgical procedures. Liposomal bupivacaine (LB) demonstrates prolonged analgesic effects, up to 72 hours. We evaluated the analgesic efficacy of TAPb using LB for patients undergoing open abdominal wall reconstruction (AWR).

Evaluation of a novel permanent capped helical coil fastener in a porcine model of laparoscopic ventral hernia repair.

Background: Existing permanent helical coil fasteners, although commonly employed for mesh fixation during laparoscopic hernia repair, are associated with peritoneal tissue attachment formation and resultant visceral complications. We evaluated attachment formation, fastener engagement, and mesh/tissue integration associated with laparoscopic fixation using a novel permanent capped helical coil fastener (HC-Capped) compared to permanent non-capped helical coil fasteners (HC-Non-Capped) in a porcine model.

Methods: Twelve female pigs underwent bilateral laparoscopic intraperitoneal fixation of Composix™ L/P Mesh (10 × 15 cm oval) with HC-Capped or HC-Non-Capped fasteners.

Benefits of Multimodal Enhanced Recovery Pathway in Patients Undergoing Open Ventral Hernia Repair.

Background: Use of Enhanced Recovery After Surgery (ERAS) pathways have evidenced improved outcomes in several surgical specialties. The effectiveness of ERAS pathways specific to hernia surgery, however, has not yet been investigated. We hypothesized that our ERAS pathway would accelerate functional recovery and shorten hospitalization in patients undergoing open ventral hernia repair (VHR).

Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement.

Objective: To evaluate the safety and efficacy of transversus abdominis muscle release (TAR) with retrorectus synthetic mesh reinforcement in a large series of complex hernia patients.

Background: Posterior component separation via TAR during abdominal wall reconstruction (AWR) continues to gain popularity. Although our early experience with TAR has been promising, long-term outcomes have not been reported.

Cell-coating affects tissue integration of synthetic and biologic meshes: comparative analysis of the onlay and underlay mesh positioning in rats.

Background: While mesh reinforcement is recognized as the optimal strategy for many hernia repairs, there remains debate on the optimal position for deployment and characteristics that lead to improved biocompatibility. Coatings are an avenue by which integration may be improved. Our aim was to evaluate tissue integration between uncoated, fibroblast- and mesenchymal stem cell-coated meshes placed as subcutaneous onlay (ON) or intraperitoneal underlay (UN).