• This is the largest midline Incisional hernia to be operated through minimal invasive method in Pune
• The patient had multiple co-morbidities, including asthma, hypertension, diabetes in addition to advanced age as risk factors

Doctors at Ruby Hall Clinic, Pune successfully treated a 65 year old patient suffering from a complex and large midline hernia through robotic-assisted surgery. The elderly patient presented with extreme pain and discomfort due to the enlarged hernia bulges also had multiple co-morbidities, including asthma, hypertension, and diabetes

Given the patient’s age, multiple co-morbidities, high BMI, and a history of three vertical C-sections, the complexity of the surgery was significantly high. To ensure the best possible outcome, the patient underwent robotic-assisted surgery, using the da Vinci system which offered a more precise, minimally invasive approach to manage the challenges of the surgery.

Dr. Suprashant Kulkarni, Sr. Consultant, General and Robotic Surgeon at Ruby Hall Clinic who led the surgery emphasised the importance of a multidisciplinary approach to improve surgical outcomes. “Our primary goal was to optimise the patient’s overall health before the surgery. As the patient was diabetic, we made sure that her blood sugar levels were under control before the surgery to avoid any risk of infections. With the help of a pulmonologist, we were able to optimise her respiratory issues, effectively improving her condition over the course of two months. As urinary and constipation issues are a common concern in elderly patients, addressing and managing these issues was necessary to ensure that the patient was in good condition for the procedure, thereby reducing the risk of complications,” he said.

The patient was adviced High protein, fiber rich diet pre operatively, in addition to exercises like walking daily for 30-60 min and to use inspiratory spirometry to optimise her lung and heart status.

Highlighting the significance of optimising the patients’ health before surgery, thereby improving the outcomes, Dr. Suprashant Kulkarni, further said, “Umbilical hernias, which affect both men and women, are more common in women due to the weakening of navel scar or weakening of vertical midline incisions (of Caesarean section) and surrounding abdominal muscles during pregnancy. In this patient’s case, a history of three vertical C-sections contributed to weakened abdominal muscles causing a large abdominal bulge (Diastasis recti) in addition to multiple incisional hernias (Called the Swiss cheese defects due to typical shape caused by the defects).

To prevent hernias in women, It’s important for women to focus on strengthening their abdominal & other core muscles in not only in their growing age but also during antenatal and postnatal periods (as per recommendations from their Drs)”.

Robotic platform ensures precise and accurate surgery and least trauma to patient’s physiology. The patient was walking on her own in the wards just 5.5 hours post-surgery, despite the long time required for the surgery and was discharged inside 48 hours post-surgery with minimal pain, tolerating full oral diet

Expressing her gratitude, the 65-year-old patient said, “I’m extremely grateful to Dr. Suprashant Kulkarni and his team for helping me recover this soon. They helped me understand the benefits of robotic-assisted surgery and explained how it can significantly reduce the chances of recurrence in the future.”

“Robotic technology, with its minimally invasive approach, is the best surgical treatment for addressing hernias. The three-dimensional vision, precision, and exceptional reach of instruments, offered by the da Vinci robotic system, enabled the correction of a large hernia through very small incisions. Any other surgical method would have required larger incisions, increasing the risk of infection, recurrence, and delayed wound healing,” Dr. Kulkarni added.