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Innovation
Advances in robotic-assisted surgery give surgeons a new way to repair hernias with greater precision, smaller incisions and quicker recovery times for patients.
What is a hernia?
A hernia develops when an internal organ or fatty tissue pushes through a weak spot in the muscles or connective tissue of the abdominal wall.
“The simplest way to think about it is as a defect in the abdominal wall,” explains Dr Jaco Botes, a surgical gastroenterologist specialising in colorectal surgery at Mediclinic Durbanville. “Once that weakness is there, it doesn't disappear. Like a small crack in a dam wall, it may slowly become bigger over time.”
Many people first notice a lump or swelling that appears when they stand, cough or strain. It often disappears when they lie down. Others experience discomfort, heaviness, or pain, particularly after physical activity or lifting heavy objects.
What causes a hernia?
Most hernias occur because of a weakness in the abdominal wall. For many people, that weakness is inherited and has been present since birth, only becoming noticeable later in life. As the abdominal wall weakens over time, pressure from everyday activities allows tissue to push through the opening.
Ageing, obesity, pregnancy, chronic coughing and previous abdominal surgery can also increase the risk of developing a hernia or making an existing one more noticeable.
Why shouldn't a hernia be ignored?
It’s important to know that a hernia will most likely not heal without surgery.
Initially, the tissue may move in and out of the opening without causing major problems. However, there’s always a risk that part of the intestine or other tissue can become trapped.
“If the bowel becomes stuck and its blood supply is cut off, it becomes a surgical emergency,” says Dr Botes.
Seeing a doctor early can help prevent problems. It also gives your surgeon time to discuss the best treatment before the hernia gets worse.
How are hernias repaired?
The goal of surgery is to return the protruding tissue to its normal position, close the defect, and strengthen the weakened abdominal wall.
“In most cases, this is done using a surgical mesh made from a specialised synthetic material,” Dr Botes explains. “The mesh acts as a scaffold that allows the body's natural healing process to create strong scar tissue, providing long-term support for the repair. The mesh gives the repair its durability. As surgeons, our job is to place it in the safest and most effective position."
How has hernia surgery evolved?
For many years, hernias were repaired through open surgery using a larger incision directly over the affected area. While this remains an excellent option in some cases, it is associated with a longer recovery and a higher risk of wound complications.
The next major advance was laparoscopic, or keyhole, surgery. With smaller incisions, patients could recover faster and spend less time in hospital. However, conventional laparoscopic instruments have limits, especially when repairing large or complex hernias.
In some laparoscopic procedures, the mesh must be placed inside the abdominal cavity, where it may come into contact with the bowel. Although this approach is effective for many patients, it can lead to adhesions or other complications years after surgery.
The advantages of robotic-assisted surgery
Robotic-assisted surgery builds on the benefits of minimally invasive surgery while overcoming many of the limitations of conventional laparoscopy.
The robotic instruments have wrist-like joints that move with far greater flexibility than standard laparoscopic instruments. This allows surgeons to work with exceptional precision, even in confined spaces, while performing complex repairs through small keyhole incisions.
"The robot allows us to perform the same repair we would do through open surgery, but with the advantages of minimally invasive surgery," says Dr Botes. “This means we can position the mesh in the ideal tissue layer, reducing the need for larger incisions while maintaining a durable repair.”
Who is robotic hernia repair suitable for?
Not every patient requires robotic-assisted surgery, and the best approach depends on the type and size of the hernia, as well as the individual's overall health.
Robotic surgery may be especially helpful for people with larger abdominal wall hernias, hernias after previous surgery, umbilical or ventral hernias, or for those who are older, frail, or overweight. For these patients, smaller incisions may reduce wound complications, lower the risk of infection, and shorten recovery time.
Although robotic surgery can take a little longer because the robotic system must be set up, many patients go home sooner and return to normal activities faster than after traditional open surgery.
A modern approach to hernia care
Robotic-assisted surgery is becoming more widely available in South Africa, offering selected patients with hernias another treatment option. While it may not be suitable for everyone, it is an encouraging development in hernia care and gives surgeons more ways to tailor treatment to each patient’s needs.