Abstract
described by Dr. Jorge Daes, principles of the enhanced view totally extraperitoneal (eTEP) has been widely used in the armamentarium of ventral hernia repair recently. Robotic assisted eTEP technique feasibility has been proved, however, a complete understanding of retromuscular abdominal wall planes and its landmarks still uncertain in a majority of general surgeons. The aim of this report is to propose a technical standardization and its anatomic concepts in the robotic-assisted eTEP ventral hernia repair. our group describes 10 key steps in a structured step-by-step approach for a safe and reproducible repair based on well defined anatomic landmarks, identification of zones of dissection and correct restoration of the linea alba. the standardization has been developed 2 years ago and applied to all patients. A robotic-assisted surgery with 3 robotic arms is performed in a lateral docking setup. Feasibility is established and reproducibility is high among general surgeons. we present a standardized side docking robotic assisted eTEP approach for ventral hernia repairs with 10 key steps. We believe understanding the landmarks and a step-by-step guidance based on the concepts of retromuscular abdominal wall anatomy foment a safe learning of minimally invasive restoration of the abdominal wall integrity regarding non-expert surgeons.
Highlights
Ventral hernias (VH) are defects in the abdominal wall fascia
Overcoming some laparoscopic and ergonomics limitations, more recently, Beliansky et al.[6] reported the use of a robotic platform in ventral hernia repair (VHR), combining the use of the Enhanced Totally Extraperitoneal” (eTEP) technique with the principles of releasing the transversus abdominis (TRA) muscle advocated by Novitsky et al.[7]
Restoration under physiological pressure of the linea alba should be the main objective of the ventral hernia repair, different than what was previously thought, i.e., only a tension-free correction
Summary
Ventral hernias (VH) are defects in the abdominal wall fascia. Their repairs are among the most commonly performed surgical procedures. Different surgical techniques for ventral hernia repair (VHR) have been described and, despite the high number of procedures, data to provide evidence and to establish best practices are scarce[1]. The laparoscopic VHR technique was first described 27 years ago and, with a similar rate of recurrence, shorter length of stay, and reduction in surgical site infection[3,4]. In 2012, Dr Jorge Daes[5] reported a new concept for exploring the extraperitoneal space, naming the technique “Enhanced Totally Extraperitoneal” (eTEP) in inguinal hernias, a notable innovation in the field of laparoscopic hernia surgery. To maintain the reliability and security of the robotic eTEP VHR, we
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