Robotic Minimally Invasive Ventral Hernia Repair With the DEXTER Robotic Surgery System (RAVEN)

Background In ventral and incisional hernia repair, robotic approaches have expanded the surgical armamentarium, particularly for extraperitoneal and retromuscular reconstructions, offering improved ergonomics, enhanced visualization, and facilitation of intracorporeal suturing. After perioperative safety and feasibility of the DEXTER Robotic Surgery System have been demonstrated in inguinal hernia repair and cholecystectomy, its application in ventral hernia repair remains to be evaluated. Aims The aim of this clinical study was to confirm the perioperative and early postoperative safety and clinical performance of the DEXTER Robotic Surgery System in patients undergoing incisional or primary ventral hernia repair. Methods We conducted a prospective study at five centers in France, Germany, and Switzerland (ClinicalTrials.gov Identifier NCT07071740) including seven surgeons. Eligible patients presented with incisional or primary midline ventral hernia smaller or equal to 8 cm. The primary objectives of the study were to document the successful completion of the ventral hernia repair procedures and to collect data on the occurrence of major complications (Clavien-Dindo grades III-V), and other adverse events perioperatively and up to 30 days post-surgery. Results 33 patients were operated for ventral hernia repair with eTEP (2), IPOM+ (2), TARUP (9) and TAPP (20) techniques. The mean age and BMI of the patients were 56 years (±15) and 27.8 kg/cm2 (±5.3), respectively. All surgeries were successfully completed as planned without conversions to open surgery. No intra-operative complications or device deficiencies were observed, and one Clavien-Dindo IIIa postoperative complication occurred. The mean skin-to-skin operative time was 97 min (±46), the console time 73 min (±39) and docking time 2.2 min (±1.3). Conclusion Our experience with VHR utilizing DEXTER confirms its feasibility and safety, with operative times aligning with those reported in the literature for other robotic platforms. The Dexter system emerges as a valuable device in the toolkit of ventral hernia repair.