İnguinal Hernilerde Robotik Onarım
Özet
Robotik cerrahi, minimal invaziv fıtık onarımında laparoskopik yaklaşımların (TAPP ve TEP) bir ilerlemesi olarak 2000 yılında FDA onayı almasıyla yaygınlaşmıştır. Teknik avantajları nedeniyle robotik süreçte çoğunlukla TAPP tekniği tercih edilmektedir. Kasık fıtığı tanısında fizik muayene ve şüpheli durumlarda ultrason yeterli olmaktadır. Ameliyatlarda fibroblast aktivitesini uyaran, polipropilen ve orta ağırlıkta meshlerin kullanımı standartlaşmıştır. Operasyon sonrası üriner retansiyon, ileus, organ ve vasküler yaralanmalar ile hematom/seroma gibi komplikasyonlar gelişebilir; ancak robotik cerrahi açık yaklaşıma göre daha az hematom riski taşır. Postoperatif dönemde hastalar genellikle iki hafta içinde iyileşerek fiziksel aktivitelerine dönebilirler. Robotik yaklaşım, laparoskopik ve açık cerrahiyle benzer nüks ve komplikasyon oranlarına sahiptir. Üç boyutlu görüntü ve gelişmiş hareket kabiliyeti sunması, özellikle obez hastalarda, ikili fıtıklarda ve açık cerrahi sonrası tekrarlayan nüks vakalarında robotik yöntemi ön plana çıkarmaktadır. Buna karşın, laparoskopik ve açık yaklaşımlara kıyasla daha yüksek maliyetli olması ve cerrah için daha uzun bir öğrenme eğrisi gerektirmesi en belirgin dezavantajlarıdır. Teknolojinin gelişmesiyle maliyetlerin düşeceği ve yöntemin daha ulaşılabilir olacağı öngörülmektedir.
Robotic surgery has become widespread as an advancement of laparoscopic approaches (TAPP and TEP) in minimal invasive hernia repair since receiving FDA approval in 2000. Due to technical advantages, the TAPP technique is mostly preferred in the robotic process. Physical examination and ultrasound in suspicious cases are sufficient for the diagnosis of inguinal hernia. The use of polypropylene and medium-weight meshes that stimulate fibroblast activity has become standard in surgeries. Complications such as urinary retention, ileus, organ and vascular injuries, and hematoma/seroma may develop postoperatively; however, robotic surgery carries a lower risk of hematoma compared to the open approach. In the postoperative period, patients generally recover within two weeks and return to their physical activities. The robotic approach has similar recurrence and complication rates compared to laparoscopic and open surgery. Offering three-dimensional imaging and advanced mobility brings the robotic method to the fore, especially in obese patients, bilateral hernias, and recurrent cases after open surgery. On the other hand, its higher cost and requiring a longer learning curve for the surgeon compared to laparoscopic and open approaches are its most prominent disadvantages. It is anticipated that costs will decrease and the method will become more accessible with the development of technology.
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