From the Research
Robotic totally extraperitoneal ventral hernia repair with mesh is best performed using the robotic preperitoneal extended totally extraperitoneal (R-PeTEP) technique, which allows for direct access to the preperitoneal space without entering the abdominal cavity, as described in the most recent study 1. The procedure begins with patient positioning in supine position and establishment of pneumoperitoneum.
- Port placement includes a camera port and two to three working ports positioned laterally to the rectus muscles.
- The initial step involves creating the extraperitoneal space by making a small incision away from the hernia defect, then carefully developing this space using blunt dissection.
- The hernia sac is identified and reduced, with adhesions taken down as needed.
- The hernia defect is measured precisely to ensure appropriate mesh sizing, typically allowing for 5-7 cm of overlap on all sides.
- The mesh (usually a composite or polypropylene mesh) is then introduced into the extraperitoneal space and positioned to cover the defect adequately.
- Mesh fixation follows, using absorbable tacks, sutures, or fibrin glue to secure the mesh in place while avoiding penetration of the peritoneum. This extraperitoneal approach minimizes the risk of adhesions and mesh-related complications while providing the benefits of minimally invasive surgery, including reduced postoperative pain and faster recovery compared to open repair techniques, as supported by the study 1. Key benefits of the R-PeTEP technique include:
- Reduced risk of neurovascular bundle injuries
- Omitting entry to the abdominal cavity
- Wide flap creation for prosthetic overlap
- Posterior plication of diastasis recti with little to no mesh fixation
- Excellent preliminary clinical outcomes, with low rates of seromas, hematomas, and ileus, as reported in the study 1.