Locations:
Search IconSearch
September 15, 2015/Digestive

Case Study: Cleveland Clinic’s First Robotic-Assisted Abdominal Wall Reconstruction

Evolving surgical techniques yield promising results

AbdominalWall-690×380

By John Rodriguez, MD

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Presentation: March 2015

A 59-year-old woman presented to Dr. Rodriguez’s office for evaluation of abdominal pain that was significantly altering her quality of life. During her examination, he found what appeared to be an abdominal hernia. A CT scan of the abdomen later confirmed this diagnosis.

She developed the hernia after an operation done to remove a cancer in the endometrium. The hernia had enlarged over time and required a more complex operation for repair. Dr. Rodriguez recommended an abdominal wall reconstruction to give this patient the best chance of a long-lasting repair. Incisional hernias can develop after abdominal operations when fascial tissues fail to properly heal. This can happen for many reasons including technical failure, wound infections or patient-related factors that affect proper wound healing.

There are many considerations that come into play when selecting the proper technique for hernia repair. The main goal is to provide patients with the best possible operation to minimize the risk of recurrence, which can be as high as 30 percent. A posterior component separation best known as a transverse abdominis release was needed to reconstruct this patient’s abdominal wall. This operation is typically performed through a large open incision and is followed by a prolonged recovery phase. The team from the Digestive Disease Institute at Cleveland Clinic has been using minimally invasive techniques to perform complex abdominal operations through small incisions. Dr. Rodriguez felt that this was a great opportunity to apply robotic technology to perform the same open operation through a laparoscopic approach.

Advertisement

Dr. Rodriguez teamed up with Michael Rosen, MD, a world renowned hernia expert who serves as Director of Cleveland Clinic’s Hernia Center to perform the first robotic assisted abdominal wall reconstruction in Ohio.

Treatment: April 2015

The patient was taken to the operating room and had a successful abdominal wall reconstruction. The use of advanced minimally invasive techniques and robotic technology, allowed the surgical team to replicate the standard open technique using only a few small incisions. The operation was uneventful. She made an unremarkable recovery and was able to leave the hospital on postoperative day 1. The benefits of this approach were seen very quickly by the patient and her medical team. Patients undergoing this kind of surgery typically stay in the hospital an average of five days and require major efforts to help control pain.

Discussion

Hernias of the abdominal wall are one of the most common problems seen by general surgeons. The evolution of surgical techniques has focused on decreasing complications and recurrence rates. Component separation techniques have proven to be the best option for patients with large or complex abdominal hernias. The use of synthetic mesh has helped decrease recurrence rates. The use of minimally invasive techniques has the potential to decrease length of stay, wound complications and improve postoperative pain.

Dr. Rodriguez is a general surgeon in Cleveland Clinic’s Digestive Disease Institute. He specializes in foregut surgery, bariatric surgery, gastroparesis, hernia surgery, advanced laparoscopy and endoscopy. He can be contacted at rodrigj3@ccf.org.

Advertisement

Advertisement

Related Articles

Female patient speaking with physician
December 16, 2024/Digestive/Research
Endometriosis Linked to Upper GI Symptoms and Higher Healthcare Usage

Better screening can improve GI outcomes and reduce costs

William Carey, MD, with patient
December 12, 2024/Digestive/Research
Hearts From Donors Infected with Hepatitis C Are Safe for Transplant, Study Shows

Findings show no increased risk in long-term outcomes

Nurse with IV
December 5, 2024/Digestive/Research
What Fluids Should I Order for My Patient With Acute Pancreatitis?

A review of current evidence and recommendations

Medication
November 29, 2024/Digestive/Research
Gastroparesis for the Nongastroenterologist (Part II)

Diagnosis and management tips

Physician speaking with patient
November 27, 2024/Digestive/Research
Gastroparesis for the Nongastroenterologist (Part I)

Tips for recognizing a complex condition

Closeup of bariatric surgery
November 18, 2024/Digestive/Research
Dramatic Microbiome Change Predicts Weight Loss Effectiveness After Metabolic Bariatric Surgery

Findings could help identify patients at risk for poor outcomes

Nurses entering information onto computers
November 8, 2024/Digestive/Research
Study Shows SGLT2i Drugs Are Safe for Patients with Cirrhosis

Findings also indicate reduced risk of serious liver events

Physician speaking with patient by computer
November 6, 2024/Digestive/Research
Model Uses Machine Learning to Predict Patients at Risk of Gastric Cancer

Promising results could lead to improved screening, better outcomes

Ad