V-046 LIRA (LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY) WITH A MANUAL ROBOTIC LAPAROSCOPIC ARM: TECHNICAL STEPS

Abstract

Abstract Introduction LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) is a minimally invasive technique for the tension-free repair of incisional hernias from M2 to M4, with low recurrence rate and less postoperative bulging and seroma formation than classic IPOM lap repair. Objective To describe the main steps of the LIRA focusing on the tension-free midline closure. The use of a robotic laparoscopic arm1 improved the surgeon's mobility range and ergonomy, facilitating the procedure. Methods A 42-year-old obese woman (BMI 34 Kg/m2), presented with a recurrent umbilical hernia M3W2, Hernia defect: 6cm.in width, (previous onlay repair with polypropylene mesh in 2020). Access: 3 Trocars at the midaxillary line. Posterior rectus sheaths were divided, and the defect was closed with a running 2/0 barbed suture. Then, the repair was reinforced with a tailored, round-shaped 15 cm. composite mesh2 fixed with a double crown of absorbable tacks3. No drain was used. Results Operating time: 85 minutes. The procedure was performed in an outpatient setting. The postoperative course was uneventful. Follow-up: 9 months. The patient remains asymptomatic and highly satisfied (9/10). No recurrence nor bulging has been observed. Conclusions The LIRA technique allowed a tension-free reconstruction of the abdominal midline when dealing with ventral hernias, without remarkable complications. LIRA provides the advantages of laparoscopic surgery in terms of less postoperative pain, morbidity (e.g. seroma, and less risk of infection), and no bulging. The use of robotized laparoscopic arms facilitates these quite complex procedures.