V-010 ROBOTIC ASSISTED BILATERAL INGUINOSCROTAL HERNIA REPAIR: STEP BY STEP

Abstract

Abstract Introduction Robotic surgery in the field of abdominal wall surgery is exponentially growing. In this video we will present a step by step robotic approach for bilateral inguinoscrotal hernia repair. Clinical case A 79 year-old male with history of hypercholesterolemia was diagnosed of bilateral inguinal hernia. On physical examination, a right inguinoscrotal hernia (EHS classification L3P) and left inguinal hernia (EHS classification M1P) were diagnosed. Minimally invasive surgery assisted by DaVinci Xi robot is decided. Under general anesthesia, a supraumbilical 8-mm trocar is located and 2 other trocars are positioned 8 cm laterally. Monopolar scissors and bipolar grasps are introduced. Laparoscopic examination confirmed the diagnosis. First, peritoneum is dissected, allowing to access to the preperitoneal space, dissecting the medial and lateral compartiment, reaching the pectineal ligament. Identification and reduction of the hernia sac is performed, individualizing and preserving the inguinal structures. Critical view of the miopectineal orifice is ensured. Contralateral procedure is performed. 15×15 cm Poplipropilene mesh are located at the preperitoneal space, fixated with 3/0 PDS stitches to the pectineal ligament. Fixation stitches are done at the superior section of the mesh. Peritoneal flaps are closed with V-lock suture. Conclusion Robotic surgery is a safe and feasible procedure for inguinal hernia repair in patients specially selected (BMI <30, bilateral hernias). Further studies are needed in order to clarify its role in the field of minimally invasive surgery.