Evidence map›Paper›PMID 40072628›Full record

ArticleHernia : the journal of hernias and abdominal wall surgery2025

Balloon dissection for robotic totally extra-peritoneal (rTEP) inguinal herniorrhaphy: description of a modified technique and report on 97 consecutive patients.

Karim S Trad, Shankar S Thiru, Thomas P Stirrat, Paul J Marino, Elizabeth R Prevou, Margaret E Greer, Yewande R Alimi

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Article in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Robotic eTEP inguinal hernia repair.Hernia : the journal of hernias and abdominal wall surgery · 2025
    Article
4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Karim S TradDivision of General Surgery, Georgetown University School of Medicine, Washington, DC, USA. karimsamitrad@gmail.com.ORCID 0000-0002-9149-707X
Shankar S ThiruGeorgetown University School of Medicine, Washington, DC, USA.
Thomas P StirratGeorgetown University School of Medicine, Washington, DC, USA.
Paul J MarinoDepartment of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
Elizabeth R PrevouThe George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
Margaret E GreerGeorgetown University School of Medicine, Washington, DC, USA.
Yewande R AlimiDepartment of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAs the use of robotic platforms for inguinal hernia repairs continues to grow, the rTAPP (Robotic Trans-Abdominal Pre-Peritoneal) approach is being performed significantly more often than rTEP (Robotic Totally Extra-Peritoneal) and is predominantly taught to newly trained robotic surgeons. This study's primary objective was to evaluate the feasibility of a proposed modified rTEP technique that incorporates balloon dissection as a primary tool, enabling the horizontal placement of three trocars aligned with the umbilicus. Secondary objectives included evaluation of safety and effectiveness of this technique, and of the learning curve required to reach proficiency.

methodsFrom February 2023 to April 2024, a total of 97 consecutive patients (87 males, 10 females) with an average age of 61 years (range 17-89) and a mean body mass index of 26 kg/m

resultsRepaired hernias included 57 indirect (46.7%), 48 direct (39.3%), 4 femoral (3.3%) and 13 mixed (10.7%). There were no conversions to open or laparoscopic surgery, and the average console time was 45 min for unilateral repairs and 68 min for bilateral repairs. 70% of patients elected not to use the narcotic prescribed for postoperative analgesia. There was one serious adverse event (1/97, 1.0%), and one unplanned return to the operating room within 30 days (1/97, 1.0%). Over an average follow-up period of 52 weeks (range 25-87 weeks), there was one recurrence (1/122, 0.8%). In our analysis of the learning curve, we found that proficiency was reached around the 24th non-complex unilateral case.

conclusionThe modified rTEP technique utilizing balloon dissection is feasible, reproducible and time efficient. This study demonstrates its safety and effectiveness. The technique provides superior visualization of the extraperitoneal space, facilitates manipulation of robotic wristed instruments, and ensures proper mesh placement. Early postoperative outcomes suggest that rTEP could play an important role in the surgical management of inguinal and femoral hernias. Further studies are needed to provide data on short and long-term quality of life, and to compare rTEP to rTAPP.

Indexed as

DissectionHernia, InguinalHerniorrhaphyRobotic Surgical ProceduresAdolescentAdultAgedAged, 80 and overFeasibility StudiesFemaleHumansLearning CurveMaleMiddle AgedOperative TimePostoperative ComplicationsBalloon dissectorInguinal herniaRobotic herniorrhaphyrTEPTotally extraperitoneal surgery

Identifiers

PMID40072628

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.