V-015 ROBOTIC TARUP: TECHNICAL DETAILS AND INNOVATIVE METHOD OF FIXATION

Abstract

Abstract Aim With the recent evolution of minimally invasive hernia repairing techniques, robotic platform has exponentially gained consensus in the field of abdominal wall surgery, leading to the placement of retromuscolar synthetic meshes avoiding the need of extensive tissue dissection as the open approach. Our aim was to describe the introduction of Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (TARUP) at a referral centre for advanced mini-invasive surgery, by reporting the preliminary experience and the technical aspects of the procedure. Material & Methods We present a case of a 3 cm umbilical defect associated to supraumbilical diastasis in a young man undergoing TARUP with the Da Vinci Xi system. The robotic boom was placed on the patient's right side, with three trocars on the anterior axillary line. The outline for the mesh was marked by centering the hernia defect with transcutaneous needles to delineate the extent of dissection corresponding to mesh area. Intra-abdominal pressure was of 8–12 mmHg. A retromuscolar plane was created starting from the incision of the ipsilateral posterior rectus sheat. The hernia content was reduced. The junction between the anterior and posterior rectus fascia was incised to cross-over the linea alba and continue the dissection controlaterally. A 15×15 cm polypropylene mesh was positioned in the retrorectus space and fixed with cyanoacrylic glue tack. Results Intervention lenght was of 100 minutes. No intra- or post-operative complications occurred. At present, no early recurrences were observed. Conclusions Robotic TARUP represents a safe and reproducible alternative in selected cases where retromuscolar mesh is preferred.