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ADVANCES AND CHALLENGES IN MINIMALLY INVASIVE SURGERY
FOR THE TREATMENT OF HERNIAS
João Pedro do Valle Varela1
Luís Filipe Silva Oliveira2
Victor Edas Corteletti Pereira Lopes3
Júlia Gaspar Calzolari4
Andressa Maria Eccard André5
Kaicki Teólo da Silva6
Henrique Djosci Coêlho de Sá7
Walter Teólo da Silva8
João Marcelo Pacheco Kokis9
Abstract: Minimally invasive surgery has revolutionized the treatment of various medical
conditions, oering signicant benets in terms of recovery and fewer complications. In the eld
of hernia surgery, technological advances and innovative techniques have provided a less invasive
approach that minimizes pain, reduces recovery time and improves aesthetic results. However,
despite notable advances, there are still challenges and limitations that need to be addressed in
order to optimize results and expand the use of these techniques. This summary examines the main
advances in minimally invasive surgery for the treatment of hernias and discusses the challenges
1 Metropolitan College São Carlos
2 Faculty Medicine of Campos
3 Estácio de Sá Campus College Barra da Tijuca
4 Iguaçu University Campus Itaperuna
5 Iguaçu University Campus V
6 Federal University of Espírito Santo
7 Resident of Family and Community Family Medicine of the University of Gurupi
8 University of Araraquara
9 Estácio de Sá Campus College Barra da Tijuca
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that remain in this eld. The aim of this paper is to review recent advances in minimally invasive
surgery for the treatment of hernias, highlighting technological innovations, improved techniques
and clinical benets. It also aims to identify the challenges and limitations associated with these
techniques, providing a comprehensive overview of the positive and negative aspects of minimally
invasive surgery in current clinical practice. This is a bibliographic review, using qualitative and
quantitative assumptions, using the PubMed, Scopus and Web of Science databases. The health
descriptors “Abdominal Hernia”, “Minimally Invasive Surgery”, “Hernia Repair”, “Hernia Mesh”
and “Technological Advances” were used to rene the research. The time frame covers the years
2015 to 2021. Advances in minimally invasive hernia surgery have been driven by the development
of advanced technologies such as laparoscopy and robotics. Laparoscopy, which uses small incisions
and a camera to guide the surgery, has established itself as the standard technique for treating
inguinal and umbilical hernias. This approach oers several advantages over traditional open surgery,
including less post-operative pain, a lower risk of infection, reduced hospitalization time and a faster
recovery. Laparoscopy allows the surgeon to accurately visualize and repair the hernia, while the
small incisions result in smaller scars and a better aesthetic appearance. Recently, robotic surgery has
emerged as a signicant innovation in the eld of minimally invasive surgery. Robotic systems oer
a three-dimensional view and greater precision during the operation, allowing for more delicate and
complex maneuvers. This technology is particularly useful in cases of complex or recurrent hernias,
where precision and control are critical. Studies have shown that robotic surgery can further reduce
post-operative pain and recovery time, although the high cost and need for specialized training are
challenges associated with this technology. However, the adoption and eectiveness of minimally
invasive techniques for hernias face several challenges. One of the main challenges is the learning
curve associated with new technologies. Laparoscopy and robotic surgery require advanced technical
skills and extensive training, which can limit access to these techniques in some medical centers
and regions. Furthermore, although minimally invasive surgery oers signicant advantages, patient
selection is crucial. Patients with very large hernias, additional complications or medical conditions
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that increase surgical risk may not benet as much from these techniques. Another challenge is cost.
The advanced technologies and equipment required for minimally invasive surgery are generally
more expensive than traditional approaches. These costs can be a barrier to widespread adoption,
especially in settings with limited budgets or where access to cutting-edge technologies is restricted.
It is concluded that advances in minimally invasive surgery for the treatment of hernias have provided
signicant benets, including less post-operative pain, faster recovery and better aesthetic results.
Technologies such as laparoscopy and robotic surgery have revolutionized the surgical approach,
oering new opportunities for treatment with less impact on the patient. However, challenges such as
the learning curve, high cost and the need for careful patient selection need to be addressed in order
to optimize practice and expand access to these techniques. As technology continues to evolve and
more data becomes available, minimally invasive surgery is expected to become even more eective
and aordable, oering continuous improvements in care and outcomes for hernia patients.
Keywords: General Surgery; Hernias; Minimally Invasive Surgeries.
INTRODUCTION
Minimally invasive surgery (CMI) has revolutionized hernias treatment, providing a less
traumatic alternative to traditional surgical techniques. The CMI, including laparoscopy, oers
several advantages, such as lower postoperative pain, faster recovery times and lower complication
rates. These techniques involve small incisions, the use of high resolution cameras and specialized
instruments, allowing surgeons to perform accurate repairs with minimal impact on surrounding
tissues. Studies have shown that patients undergoing CMI to treat hernias experience a faster return
to daily activities compared to those undergoing traditional open surgeries (Bittner et al., 2015).
Despite signicant advances, minimally invasive surgery for hernias treatment still faces
important challenges. The learning curve for surgeons who perform laparoscopic procedures can be
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steep, requiring specialized training and constant practice. In addition, the CMI may not be appropriate
for all types of hernias or for all patients, particularly those with large or complex hernias, or with
pre -existing medical conditions that increase surgical risk. Proper selection of patients is crucial to
maximizing the benets of CMI and minimizing the risk of complications (Fitzgibon et al., 2019).
Continuous innovation in CMI techniques and technologies is contributing to overcoming
some of these challenges. The development of more sophisticated laparoscopic instruments and the
introduction of robotic surgery are expanding the possibilities of CMI. Robotic surgery, in particular,
oers greater accuracy and control, allowing complex procedures more easily. In addition, augmented
and virtual reality platforms are being explored to improve surgical training and preparation for
specic procedures, potentially reducing the learning curve and improving clinical results (Stoel &
Ipaktchi, 2017).
Another crucial aspect in the advancement of the HM CMI for the treatment of hernias is
the improvement of materials used for hernia repair, such as reinforcement screens. New generations
of biocompatible screens are designed to better integrate with surrounding tissue, reducing the risk
of rejection and infection. Continuous biomaterial research is focused on developing solutions that
provide adequate and lasting support, while minimizing the complications associated with implants.
These innovations are continually evaluated in clinical studies to validate their ecacy and safety
(Englisch et al., 2020).
This work examines the main advances in minimally invasive surgery for herniary treatment
and discusses the challenges that persist in this eld, reviewing recent advances in minimally invasive
surgery for hernias treatment, highlighting technological innovations, enhanced techniques and
clinical benets. In addition, it is intended to identify the challenges and limitations associated with
these techniques, oering a comprehensive view of the positive and negative aspects of minimally
invasive surgery in current clinical practice.
MATERIALS AND METHODS
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This is a bibliographic review, using qualitative and quantitative assumptions, with the
Pubmed, Scopus and Web of Science databases. For the renement of the research, the descriptors in
“hernia abdominal”, “minimally invasive surgery”, “hernia repair”, “knitted hernia” and “technological
advances” were used. The temporal cut covers the years 2015 to 2021.
● Inclusion criteria:
1. Studies published between 2015 and 2021.
2. Publications in English.
3. Articles revised by pairs.
4. Studies that address abdominal hernia repair techniques, including laparoscopy and
robotics.
5. Studies that discuss advances in mesh materials and postoperative pain management in
hernia.
6. Systematic revisions, meta-analysis and relevant clinical studies.
● Exclusion criteria:
1. Studies that do not directly address minimally invasive techniques for hernia repair.
2. Publications outside the specied temporal scope.
3. Articles not available in full.
4. Studies with qualitative methodologies without relevant quantitative data.
5. Reports of isolated cases or small case series (n <20).
● Boolean markers
To perform the search in the databases, the following boolean markers were used:
- “Abdominal Hernia Repair” and “Minimally Invasive Surgery” and “Mesh Materials”
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- “Laparoscopic Hernia Repair” and “Robotic Surgery” and “Pain Management”
- “Hernia Surgery” and “Advances in Techniques” and “Postoperative Outcomes”
● Nursening question
The guiding question of this study was: “What are the advances and results of minimally
invasive techniques in abdominal hernia repair, including the use of meshes and robotic approaches?”
THEORETICAL FOUNDATION
Minimally invasive surgery (CMI) has revolutionized hernias treatment, oering signicant
benets compared to traditional surgical techniques. Advances in technology, such as the development
of laparoscopic and robotic techniques, have allowed complex procedures to be performed with less
trauma for the patient and faster recovery. Laparoscopy, for example, uses small incisions and a
camera to guide surgery, which reduces recovery time and improves the aesthetic result. Studies
show that laparoscopy results in less postoperative pain and faster recovery compared to open surgery
(Simons et al., 2019).
However, the implementation of minimally invasive surgery faces signicant challenges.
One of the main challenges is the learning curve associated with laparoscopic and robotic techniques.
The complexity of tools and the need for specialized skills to handle them can limit widespread
adoption of these techniques, especially in less resource centers. In addition, the need for extensive
training for surgeons and the acquisition of expensive equipment may represent nancial barriers to
many institutions (DUCASSE et al., 2021).
Another important challenge is the proper selection of patients for minimally invasive surgery.
Not all hernias are suitable for this type of procedure, and the decision on the surgical approach
should take into account factors such as hernia size, the presence of complications and the general
condition of the patient. Careful evaluation and customization of treatment are essential to ensure
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that minimally invasive surgery is the best option for each patient. Studies indicate that appropriate
selection can improve results and reduce the risk of complications (Leblanc et al., 2020).
In addition, the cost of minimally invasive procedures can be a signicant concern. Although
minimally invasive surgery can reduce costs associated with recovery time and postoperative
complications, initial equipment and training costs can be high. Comparative economic analysis
between minimally invasive surgery and traditional approaches is fundamental to evaluate cost-
benet and justify investment in new technologies (Berrevoet et al., 2022).
On the other hand, continuous advances in technology and technique have the potential
to overcome many of these challenges. Innovations such as the integration of computer assisted
navigation systems and the improvement of laparoscopic suture techniques are contributing to the
evolution of minimally invasive surgery. These innovations aim to increase procedures accuracy and
further reduce associated risks (SROKA et al., 2021).
As a result, in addition to technological advances and clinical challenges, the evolution of
minimally invasive techniques for hernias treatment is also closely linked to the improvement of
operational practices and protocols. The integration of advanced imaging systems and the use of
high denition visualization techniques have improved the accuracy of the surgeries. The ability
to clearly visualize anatomical structures during the procedure allows a more accurate and less
invasive approach. These advances in imaging technology contribute to the reduction of errors and
complications during surgery, improving patient results and safety (Mason et al., 2018).
Moreover, the integration of assistive technologies, such as intraoperative navigation systems
and robotic assistance devices, has played an important role in optimizing minimally invasive
procedures. These systems provide additional support during surgery, helping surgeons perform
more accurate movements and maintain more rened control over instruments. Robotic assistance,
for example, has shown benets in terms of reducing surgeon fatigue and increasing accuracy, which
may translate into better operating results and faster recovery for patients (Gurusamy et al., 2020).
The development of advanced CMI techniques is also complemented by improvements
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in postoperative care. The rapid recovery provided by minimally invasive techniques requires
an appropriate approach to postoperative management. Improved analgesia protocols and pain
management strategies have been implemented to ensure that patients experience as little discomfort as
possible. The implementation of optimized postoperative care, such as early mobilization and directed
rehabilitation, contributes signicantly to the rapid recovery of patients and decreased complications
(Kothari et al., 2019).
In addition, long -term ecacy and safety research for minimally invasive techniques remains
an important focus. Although CMI oers many advantages, it is crucial to continuously monitor
and evaluate its long -term results, including repair durability and rear herniles. Follow -up studies
and additional research are required to validate long -term benets and to identify any potential
disadvantages associated with these techniques. This continuous monitoring is essential to ensure
that minimally invasive practices evolve to maximize positive results for patients (Feng et al., 2021).
CONCLUSION
Advances in minimally invasive surgery (CMI) have transformed hernias treatment, oering
a more eective and less invasive approach compared to traditional techniques. CMI, including
laparoscopy and robotic surgery, provides signicant benets such as reducing postoperative pain,
lower recovery time and lower risk of complications. The ability to perform procedures with less
impact on surrounding and more accurate tissues has contributed to the general improvement of
surgical results and the rapid recovery of patients.
However, the successful implementation of the CMI for the treatment of hernias faces
important challenges. The learning curve for surgeons, proper selection of patients and the need
for specialized training remains critical issues. Continuous evolution of technologies, such as the
introduction of advanced imaging systems and robotic assistance, is helping to overcome some
of these challenges, providing additional support and improving the accuracy of procedures. The
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integration of these technologies, coupled with improvements in postoperative care and innovation in
repair materials, has the potential to further optimize CMI results.
It is essential that research and practice continue to evolve to monitor long -term results
and address any potential disadvantages associated with minimally invasive techniques. Continuous
monitoring of patients and long -term benets validation is essential to ensure that minimally invasive
techniques continue to oer the best solution for hernias treatment. With continuous innovation and the
adoption of evidence -based practices, minimally invasive surgery can continue to provide excellent
results for patients, signicantly improving the quality of treatment and recovery.
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