That's because a lot of things can go wrong if surgeons aren't totally
comfortable with the complex anatomy of the area. They have to
watch out for the iliohypogastric, ilioinguinal and genitofemoral
nerves. The spermatic cord and its associated structures are vulnera-
ble. The bladder and other organs are right nearby. If they use tacks,
the tacker can cause injuries. Even if they do everything else right, if
the dissection isn't wide enough, there's likely to be a recurrence.
Same thing if the mesh the surgeon uses is too small.
It's no wonder that some say it takes about 250 laparoscopic
inguinal hernia repairs to ease the anxiety and become truly comfort-
able with the procedure. Others say 250 is actually optimistic, that
complications don't really begin to plateau at an acceptable level until
you have about 500 laparoscopic hernias under your belt (so to
speak).
So it's also no wonder that most general surgeons continue to use
the open approach, despite study (osmag.net/vdd3cm) after study
(osmag.net/js2ofe) showing that patients who have laparoscopic
repairs are less restricted and less likely to experience chronic pain,
even as long as 5 years after the procedure.
Open and closed
The beauty of robotics is that it gives you the best of both worlds.
From a technical standpoint, it's much easier to perform most opera-
tions robotically than laparoscopically. The way your hands move and
how you hold the needles is much more intuitive, much more like a
replication of an open surgery.
With a robot, you're basically operating on the inside the way you
would in an open procedure. But on the outside, it's minimally inva-
sive, with less scarring and all the other benefits of laparoscopy.
That's a great combination.
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