Wiki Open vs laparoscopic robotic assisted inguinal hernia repair

[abney.pam@mhsil.com]

Does anyone know if there is a definitive size of an incision that determines whether a robot assisted laparoscopic hernia repair coverts to open? A general surgeon of ours often uses the same words to describe his procedure but I am having a hard time with it because he does not say "convert to open". Here is that part of the dictation after the abdomen was insufflated and trocars were placed: Robot was brought in. Camera arm was attached. Target anatomy was performed. Remaining trocars were attrached to the camera arms and surgical instruments were passed under direct vision. At this point, I scrubbed out and my assistant was on the patient's side. The transverse incision is mad about 7 cm, starting from the right medial umbilical ligament laterally, staying just above the hernia defect. Medially, a large pocket is created extending to the retropubic area enough to accommodate the hernia mesh. Laterally, inferior flap was mobilized as well. The cord structures were mobilized from the hernia sac. Hernia sac along with large cord lipoma was reduced due to large size. It requires meticulous dissection to pull out the hernia sac. Next superior flaps were created in the peritoneum and now the flaps were mobilized superiorly, inferiorly, laterally, and medially enough to accommodate the large hernia mesh. At this point, prograf mesh was rolled hydrated and delivered intraperitoneally, along with 3-0 stitch. Mesh was placed and opened in such a way that there is at least 5 cm overlap inferiorly. Mesh lies back. Abdomen was desufflated to 8mm and peritoneum was then approximated using 3-0 stitch, and while closing the peritoneum, the reduced preperitoneal fat was incorporated into the closure to prevent reherniation. Robot was undocked. Abdomen deflated, trocars removed. All surgical sites were closed with 4-0 monocryl stitch.

Thanks in advance for any tips on this.

 

[csperoni]

While I rarely code inguinal hernia repairs, I am reading this as the entire procedure was done laparoscopically with the robot. The last few sentences state the robot was undocked, abdomen deflated, trocars removed. If the procedure was open, the abdomen would have lost pneumoperitoneum (fancy way to say the abdomen was still full of air).
Maybe it would help if you highlighted where you think the conversion took place.
It can be helpful to speak with clinical staff to help learn some specialty specific nuances, particularly if this is a physician or specialty you code for on a regular basis. If you feel approaching and discussing with the physician seems intimidating, a PA/NP, scrub nurse, or resident can all be very helpful in rounding our your medical knowledge.