Study 1
Repairing a trapped groin hernia in an older patient with several health conditions
The problem
When a hernia becomes trapped ("incarcerated"), the tissue cannot be pushed back and surgery is needed promptly to prevent the bowel or fat inside from losing its blood supply. In older patients who also have heart, lung or other medical conditions, the operation and the anaesthetic carry higher risk, and surgeons have traditionally favoured open surgery in this setting.
What we did
This report describes a robot-assisted TEP repair in an elderly patient with multiple medical conditions and an incarcerated groin hernia. The trapped tissue was freed and returned, the weakness reinforced with mesh fixed with dissolvable glue, all through small incisions and without entering the abdominal cavity.
Why it matters for patients
The report describes the surgical steps, the anaesthetic considerations, the patient's recovery and follow-up. It is intended to show other surgeons that, in carefully selected higher-risk patients, a minimally invasive robot-assisted approach can be considered for a trapped hernia rather than defaulting to open surgery. Whether it is appropriate depends on each patient's fitness, the state of the hernia and the surgical team's experience.
The study
Robotic Totally Extraperitoneal Repair of an Incarcerated Inguinal Hernia in an Octogenarian with Multiple Comorbidities: A Case Report
S Florica, R Keeley, O Florica · Case report
Manuscript prepared for submission — Hernia
Study 2
A non-surgical option for bile-duct stones after gastric bypass
The problem
Rapid weight loss after bariatric surgery increases the chance of forming gallstones. Occasionally a stone passes into the bile duct. The usual treatment is an endoscopic procedure through the mouth (ERCP), but after gastric bypass the rearranged anatomy makes this very difficult, and the alternatives are more invasive procedures.
What we did
This report describes a patient with small bile-duct stones after gastric bypass who was managed with a tablet medication (ursodeoxycholic acid, a well-established treatment for dissolving certain gallstones) combined with careful monitoring of blood tests and imaging, avoiding a further invasive procedure.
Why it matters for patients
For the right patient with small stones and no signs of infection or blockage, a monitored, medication-based approach may be an option to discuss. It is not suitable when there is infection, jaundice, a large stone or ongoing pain, and it requires close follow-up. The report is shared so that other clinicians are aware of this option in this specific and uncommon situation.
The study
Conservative Management of Common Bile Duct Stones with Ursodeoxycholic Acid in Multiply-Revised Roux-en-Y Gastric Bypass Anatomy: A Case Report
S Florica, R Keeley, O Florica · Case report
Manuscript prepared for submission — Journal of Gastroenterology
Study 3
Repairing a femoral hernia with robot-assisted keyhole surgery, with long-term follow-up
The problem
Femoral hernias are a less common type of groin hernia, more frequent in women, and are more likely than other groin hernias to become trapped and need emergency surgery. They are often repaired through an open incision.
What we did
This report describes a robot-assisted TEP repair of a femoral hernia. The technique places mesh behind the abdominal muscles so that it covers the femoral opening and the other potential hernia sites in the groin at the same time, fixed with dissolvable glue rather than metal.
Why it matters for patients
Covering all groin hernia sites in one repair is intended to reduce the chance of a different hernia appearing next to the repair later. The report documents the technique step by step, the patient's recovery and follow-up over several years, adding to the evidence that robot-assisted keyhole repair can be applied to this type of hernia. As always, the right operation depends on the individual.
▶ Watch the femoral hernia repair technique video
The study
Robotic Totally Extraperitoneal Femoral Hernia Repair: A Novel Technique with Seven-Year Follow-Up
S Florica, R Keeley, O Florica · Original article
Manuscript prepared for submission — Journal of Robotic Surgery
Study 4
Repairing hernias on both sides — one recurrent — in a patient with heart disease
The problem
Some patients have hernias in both groins, and some have a hernia return after a previous repair. Operating on a recurrence is more difficult because of scar tissue, and patients with significant heart conditions face extra anaesthetic risk, particularly if the abdomen must be inflated with gas for keyhole surgery.
What we did
This report describes a robot-assisted TEP repair of both groins in a single operation in a patient with heart disease — one side a recurrent hernia after earlier surgery, the other a new hernia. Working behind the abdominal muscles allowed the recurrent side to be approached in fresh tissue rather than through old scar, and both sides were reinforced with mesh fixed with dissolvable glue.
Why it matters for patients
Repairing both sides in one anaesthetic avoids two separate operations and recoveries. Because only the small space behind the muscles is inflated, the pressure on the heart and lungs during surgery may be lower than in conventional keyhole repair, which can be relevant for patients with cardiac conditions. The report describes the technique, the recovery and follow-up over several years. Suitability is always assessed individually with the surgeon and anaesthetist.
The study
Robotic Totally Extraperitoneal Bilateral Inguinal Hernia Repair Including a Recurrent Hernia in a High-Risk Patient: A Case Report with Seven-Year Follow-Up
S Florica, R Keeley, O Florica · Case report
Manuscript submitted — Journal of Surgical Case Reports
All patient details in these studies are de-identified. Summaries reflect the manuscripts as prepared; wording may differ from the final published versions.