inguinal hernias.
But the technique shouldn't be widely adopted yet. It's tricky to
learn, and you definitely need to know your pelvic anatomy. It's an
option for patients who want the benefits of laparo-scopy or robotics
without the risks of mesh-related complications. Of course, that does-
n't mean there are no potential complications; it's just that potential
mesh-related issues are out of the picture. We make sure patients
know that if they recur from this, they'll need to have mesh-based
inguinal hernia repair.
The advent of robotics has been transformative. Robotic surgery lets
us minimally invasively handle complicated procedures that previous-
ly would have had to have been done in an open fashion. That's
because the technology lets you operate in the abdomen similarly to
how you would operate during an open procedure. Robotics also pro-
vides an opportunity for many surgeons to offer minimally invasive
surgery despite having little or no experience with laparoscopic her-
nia repair, which is difficult to master. In the absence of competition,
robots remain a luxury that most outpatient surgery centers and many
hospitals can't afford. But they still represent a big step forward.
Time to listen
When I analyze the patients who are referred to me for chronic pain
after hernia repair, I sometimes see how a different technique or a dif-
ferent size or type of mesh might have prevented the complication. In
most cases, the mesh, in and of itself, didn't contribute to the compli-
cation.
Still, the reality is we don't have a perfect mesh. There are design
flaws with many types. For example, their design might not prevent
erosion into the spermatic cord or entrapment of nerves. I hope indus-
try listens to the patient movement and makes mesh that's less likely to
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