Laparoscopic transversus abdominus muscle release with pre-peritoneal access (L-TAR); an improved method for access and performance of minimally invasive TAR

Danny A Sherwinter, Director, Minimally, Invasive, Surgery. Maimonides Medical Center

The transversus abdominus muscle release (TAR) technique for abdominal wall reconstruction has recently garnered wide interest and rapid adoption.  In the TAR technique, the rectus sheath is traditionally accessed from the midline followed by division of the transversus abdominus muscle and development of the lateral pre-peritoneal plane, a medial to lateral approach.

The robotic platform is particularly well suited for the off axis dissection and suturing needed to mimic the open technique.  The difficulty in performing many of these maneuvers laparoscopically, has led some to champion the robotic TAR as one of the only, if not the only, minimally invasive general surgical procedure made possible by the robotic platform.

The technical aspects of our new technique using a pre-peritoneal pelvic access point coupled to a lateral to medial dissection schema to perform a completely laparoscopically TAR (L-TAR) are reviewed.  This improved technique resolves many of the issues encountered during the classic TAR and is readily adapted to the laparoscopic technique.  We further review our experience with this technique in our first 10 cases including operative time, cost, postoperative pain and short term outcomes.

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