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.
A 55-year-old female has a history of multiple abdominal surgeries including laparoscopic cholecystectomy, appendectomy, laparoscopic hysterectomy, tubal ligations, and multiple cesarean sections through a low transverse (Pfannensteil) incision. Cross-sectional imaging demonstrated multiple midline hernias ranging from 1–3 cm, a rectus diastasis measuring 4 cm wide, and intraparietal cesarean section (C-section) hernia (Zanellato Type II). She underwent a robotic retromuscular extended totally extraperitoneal (eTEP) repair wherein her ventral midline hernias, rectus diastasis, and intraparietal hernia were all repaired and reinforced with wide mesh overlap. This case highlights the strengths of an eTEP approach, the decision making behind considering all of a patient’s abdominal wall pathology, and the considerations with intraparietal hernias post C-section.
A 58-year-old patient underwent robotic bilateral transversus abdominis release (TAR) for repair of a recurrent incisional hernia following prior hernia repair complicated by mesh infection and subsequent explantation. This approach was selected based on the patient’s surgical history, the size of the hernia defect, and the extent of incarcerated small bowel. A double-docking technique was employed to facilitate bilateral TAR, and a large macroporous polypropylene mesh was placed. This case highlights the operative decision-making involved in complex hernia repair and demonstrates the technical considerations for performing a robotic bilateral TAR.
There is no consensus on the optimal method of ventral hernia repair, and the choice of techniques is typically dictated by a combination of patient factors and surgeon expertise. Component separation techniques allow medial advancement of the rectus abdominis muscle to create a midline tension-free fascial closure.
In this case, we describe a posterior component separation with retrorectus mesh placement, also known as a Rives-Stoppa retromuscular repair. With low morbidity and mortality, this technique provides a durable repair with low rates of recurrence and surgical site infection while providing dynamic muscle support and physiologic tension, preventing eventration, and allowing incorporation of mesh into the existing abdominal wall.
In this case, Dr. Rockson Liu with Epic Care at Alta Bates Summit Medical Center performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
Rockson C. Liu, MD, FACS General Surgery, Epic Care, Alta Bates Summit Medical Center
In this case, Dr. Rockson Liu performs a robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia that was partially reducible but mostly incarcerated, and greater than 6 cm in a 63-year-old female. Robotic ports were placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces were combined with a preperitoneal bridge of the peritoneum. The defects were closed robotically, and a medium-weight, macroporous polypropylene mesh was placed within the retrorectus space.
