Tag Archives: rTAPP

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Femoral Hernia Repair

Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Femoral Hernia Repair
Katie A. Marrero, MD1; Eric M. Pauli, MD, FACS, FASGE, FEBSAWS (Hon.)2
1Henderson Hospital, NV
2Penn State Health Milton S. Hershey Medical Center

Femoral hernias are an uncommon cause of groin pain but occur more frequently in women than men and are often overlooked during clinical evaluation and imaging review. Failure to recognize these “hidden” hernias may lead to persistent symptoms despite previous inguinal hernia repair.

A 43-year-old woman presented with chronic left groin pain despite prior open left inguinal hernia repair with mesh plug placement. Her medical history included cesarean section and abdominoplasty, with pain initially attributed to postoperative nerve injury. A CT scan obtained in 2023 was interpreted as negative for recurrent hernia; however, retrospective review demonstrated an obvious left femoral hernia adjacent to the previously placed mesh plug. She subsequently underwent treatment for May-Thurner syndrome with left common iliac vein stenting without improvement in symptoms. Clinical examination, office ultrasound, and re-evaluation of prior imaging confirmed the diagnosis of a symptomatic femoral hernia.

A robotic transabdominal preperitoneal (rTAPP) repair was performed. After establishing abdominal access and creating a generous preperitoneal flap, the myopectineal orifice was completely exposed. The previously placed mesh plug was identified medial to the inferior epigastric vessels and largely left undisturbed with only a small portion excised to facilitate flat placement of new mesh. The femoral hernia sac and incarcerated preperitoneal fat were reduced, the round ligament was divided, a large preperitoneal mesh was positioned to cover the femoral canal and all potential groin defects, and the peritoneal flap was closed.

This case demonstrates the importance of maintaining a high index of suspicion for occult femoral hernias in women with persistent groin pain, particularly following previous anterior inguinal hernia repair. Robotic TAPP repair provides excellent visualization of the entire myopectineal orifice and enables definitive treatment while preserving previously implanted mesh when appropriate.

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Repair for Ventral Hernias

Robotic-Assisted Transabdominal Preperitoneal (rTAPP) Repair for Ventral Hernias
Daphne Y. Lu, MD, MPH, MBA; Olivia Ziegler, MD; Saamia Shaikh, DO, JD; Jerome R. Lyn-Sue, MD, FACS
Penn State Health Milton S. Hershey Medical Center

This case describes a 58-year-old man who developed a symptomatic incisional ventral hernia following a trauma laparotomy and left nephrectomy after a motor vehicle collision. The patient presented with multiple midline hernia defects associated with bulging and discomfort. This video demonstrates a robotic transabdominal preperitoneal (rTAPP) repair with mesh. The case highlights practical strategies for managing intra-abdominal adhesions and a prior gastrostomy site, while outlining alternative operative approaches for cases in which preperitoneal flap development is technically challenging.

General Surgery, Print Release

PUBLISHED: Robotic-Assisted Laparoscopic (rTAPP) Umbilical Hernia Repair with Intra-abdominal Preperitoneal Underlay Mesh (IPUM)

Robotic-Assisted Laparoscopic (rTAPP) Umbilical Hernia Repair with Intra-abdominal Preperitoneal Underlay Mesh (IPUM)
Chloe A. Warehall, MD1; Divyansh Agarwal, MD, PhD1; Charu Paranjape, MD, FACS1,2
1Massachusetts General Hospital
2Newton-Wellesley Hospital

An umbilical hernia occurs due to weakened umbilical fascia or at the site where the involuted umbilical vessels exited. Depending on the hernia contents—preperitoneal fat, omentum, or small intestine—symptoms may include a new bulge at the umbilical site, abdominal pain, tenderness to palpation, color changes to the surrounding skin, as well as obstructive symptoms such as nausea, emesis, and constipation. Given that umbilical hernias tend to have narrow necks compared to size of the sac, incarceration and strangulation are relatively common. Elective repair of symptomatic umbilical hernias is done to minimize these risks.

Here we present the case of an 81-year-old male with a recurrent umbilical hernia who first presented secondary to obstructive symptoms caused by an incarcerated umbilical hernia. After reduction was successful, he underwent an elective robotic transabdominal (rTAPP) umbilical hernia repair with intra-abdominal preperitoneal underlay mesh (IPUM). This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.