Approximately 350,000-500,000 ventral hernia repairs are performed each year in the United States. A hernia, in general, occurs when there is a hole in an area of weakness in the muscles of the abdominal wall, allowing a loop of intestine or abdominal tissue to push through the muscle layer, creating a balloon-like sac.
Specifically, a ventral hernia is a term that applies to all hernias that occur at any location along the midline (vertical center) of the abdomen wall, usually larger in size.
There are three types of ventral hernias:
- Epigastric (stomach area) Hernia: Occurs anywhere from just below the breastbone to the navel (belly button). This type of hernia is seen in both men and women.
- Umbilical (belly button) Hernia: Occurs in the area of the belly button.
- Incisional Hernia: Develops at the healed site of a previous surgery. Up to one-third of patients who have had an abdominal surgery will develop an incisional hernia at the site of their scar. This type of hernia can occur anytime from months to years after an abdominal surgery.
Massive ventral hernias are those that have a length or width of at least 15 centimeters (cm) or an overall area of 150 cm2, according to the Journal of American Surgery. They pose a serious surgical risk.
Causes of a Ventral Hernia
Natural weaknesses in the wall of the abdomen can predispose someone to the development of a hernia at any age or any gender. Causes and risk factors of Ventral Hernias include:
- Weakness at the incision site of a previous abdominal surgery (which could result from an infection at the surgery site or failed surgical repair/mesh placement).
- Weakness in an area of the abdominal wall that was present at birth.
- Weakness in the abdominal wall caused by conditions that put strain on the wall such as obesity, injuries to the bowel area, pregnancy, severe vomitting, prostate gland enlargement, and old age.
Symptoms of a Ventral Hernia
Some patients do not feel any discomfort in the early stages of ventral hernia formation. The first sign is a visible bulge under the skin in the abdomen or an area that is tender to the touch. The bulge may flatten when lying down or pushing against it.
Generally, however, most patients with ventral hernias describe mild pain, aching or a pressure sensation at the site of the hernia. The discomfort worsens with any activity that puts a strain on the abdomen, such as heavy lifting, running, sitting, or standing for long periods of time, or bearing down and straining during bowel movements.
Robotically-Assisted Surgery with
The Da Vinci® Robotic Surgical System
Surgical robotics for minimally invasive surgery
As a Board-Certified General Surgeon, Dr. David W. Ford operates with a minimally invasive robotic system to repair ventral and inguinal hernias. This minimally invasive approach only requires one or a few small incisions that doctors use to insert surgical equipment and a camera for viewing.
Robotically assisted surgery utilizes an advanced robotic platform that is not autonomous but is controlled by the surgeon who is seated in the operating room and operates via the Surgeon Console that controls the Patient Cart’s robotic devices, including various surgical instruments and a camera. The da Vinci Surgical System allows surgeons to perform various minimally invasive hernia repairs with clinically supported precision and accuracy.
Robotically assisted surgery uses a laparoscope (a thin lighted tube with a camera on the tip) that is inserted through one of several small incisions, made away from where the hernia has occurred. The images gathered from the laparoscope’s camera are high-definition 3D, which are sent to a monitor that Dr. David W. Ford uses to guide the surgical system during the operation.
If needed, the abdomen can be inflated with a harmless gas (carbon dioxide), which creates space to allow the doctor to view the inside of the body. The peritoneum (the inner lining of the abdomen) is cut to allow Dr. David W. Ford to see the weakness in the abdominal wall. Surgical mesh material is usually inserted to strengthen the weakened area in the abdominal wall. After the procedure is completed, the small incisions in the abdomen are closed with a stitch or two or with surgical tape. While robotic surgery can be used for some smaller hernias or weak areas, it can now also be used to reconstruct the abdominal wall. Dr. David W. Ford’s use of the state-of-the-art da Vinci Surgical System in his robotically assisted hernia repair surgeries has allowed him to set a very high standard of expertise that can combine this method with traditional Open Surgery if required.
Many robotically-assisted surgical systems are FDA approved and in use today. However, many are specially designed for specific organs, procedures, or conditions, such as lung or pulmonary surgeries or knee and other extremity replacement surgeries. The da Vinci Robotic Surgical System is the premier system specialized in hernia repair surgery. Dr. David W. Ford is not only an expert board-certified surgeon but also certified in the use of this leading-edge technology.
This robotic platform offers Dr. David W. Ford fully wristed instruments and a 3D high-definition camera with 10x magnification. As a result, the repair can be done with more precision, and complex hernias can be fixed with small incisions. Furthermore, the robot doesn’t get tired and Dr. Ford sits during surgery, so there is less surgeon fatigue. For the patient, this translates into quicker recovery, less pain, and fewer complications. This is the preferred approach for medium to large hernias and many inguinal hernias as it combines the best of open and laparoscopic surgeries. Also, Dr. Ford is more likely to be able to sandwich the mesh between layers of the abdominal wall to keep the mesh from coming into contact with the intestines.
Other benefits of robotic hernia surgery include:
- Access to clear three-dimensional images (unlike laparoscopic surgery’s two-dimensional images) of the inside of the abdomen for more precise surgery.
- Dr. Ford can easily use stitches to sew tissue and meshes into the inside of the abdomen.
- The patient is left with smaller scars rather than one large incisional scar.
- The possibility of much less pain, faster recovery, and quicker return to normal diet and activities after surgery are observed, compared to all other types of hernia repair surgery.
Should robotically-assisted surgical laparoscopic surgery be recommended as part of treatment for your hernia repair, Dr. David W. Ford and his team will have the best state-of-the-art technology at their disposal to usher in your recovery.
How The Da Vinci® Robotic Surgical System works
Da Vinci surgical systems are comprised of three components: surgeon console, patient-side cart, and vision cart.
Surgeon Console
Patient Cart
The patient-side cart is positioned near the patient on the operating table. It is where the instruments used during the operation move in real time in response to your surgeon’s hand movements at the surgeon console.
A camera provides a high-definition, 3D magnified view inside your body. Every hand movement your surgeon makes is translated by the da Vinci system in real time to bend and rotate the instruments with precision.
Vision Cart
The vision cart makes communication possible between the components of the system possible, and supports the 3D High Definition vision system.
Open Ventral Surgical Hernia Repair:
Open surgery is the preferred method of surgery when the hernia is either very small or very complex. A complex hernia repair may require mesh removal, resection of the abdomen, or removal of extraneous skin or fat, and therefore is easier with open surgery. The open surgery requires that the incision be made in the abdomen exactly at the location where the hernia has occurred, and then the intestine or abdominal tissue is pushed back into place. Synthetic mesh material is placed to reinforce this repair and reduce hernia recurrences. The skin is then closed with dissolvable stitches and glue.
Non-Surgical Options:
- Conservative, watch & wait management is helpful for patients with minimal or no symptoms.
- The hernia itself should not limit your ability to engage in your usual daily activities.
Surgical Options:
Hernia repair involves an operation, with overall one of two main approaches:
- Mesh repair – the use of mesh to enhance the repair & provide further reinforcement
- Non-mesh repair – closing the abdominal defect with stitches, creating some tension
Safety of Surgical Mesh:
- There is a large volume of data on the outcome of various hernia operations and different types of mesh, and the use of mesh to repair the majority of hernias has been the preferred method in the US, UK, and worldwide for over 30 years.
- When surgeons themselves have hernias that require surgery, they opt for mesh repairs.
- Patient safety is a critical component, and therefore, different meshes used in surgery are tightly regulated in both the US and UK.
What is the “Gold Standard”?
- Using mesh has become the gold standard in hernia repairs – and has a lower recurrence rate.
- Many patients with hernias have tissue weakness and often do not hold stitches well, which may explain why non-mesh repairs have a higher failure/recurrence rate than with mesh.
- For the vast majority of patients, mesh poses little if any additional risk.
Risks of Mesh:
- Mesh is a foreign material, like synthetic implants, such as dentures, crowns, heart valves, etc.
- It is possible for mesh to become infected, but this is rare.
- Some patients develop chronic pain after surgery. There is no strong relationship with the use of mesh and chronic pain. Furthermore, non-mesh repairs can result in similar pain outcomes.
