Adam J Blau, MD. Albany Medical Center
Introduction: Complex ventral incisional hernia repair (VIHR) continues to be performed via an open and laparoscopic approach. However, new robotic approaches allow for the primary closure of a fascial defect, with restoration of the abdominal wall in the midline, and with extraperitoneal mesh placement.
Single dock robotic VIHR with components separation is a safe and reproducible operation. While there is limited data on this approach, we hypothesize that relative to an open or laparoscopic approach, this approach affords similar recurrence rates, decreased seroma formation rates, and decreased rates of surgical site infections.
Case: We present here the case of a 42-year-old obese female (BMI 45), who presented electively with a symptomatic ventral incisional hernia. We offered her a single dock robotic VIHR using the Si Davinci System, with bilateral posterior rectus release, unilateral transversus abdominis release (TAR), and placement of mesh in the retrorectus space.
After docking the robot, a lysis of adhesions is performed, and the Swiss cheese-like hernia defect is visualized. The hernia sac is first excised. Next, the posterior rectus fascia contralateral to the camera port is incised. The lateral aspect of this rectus muscle is identified, and a TAR is performed on this side. Then, the posterior rectus fascia ipsilateral to the camera port is incised. Upon completion of these releases, enough length is created in order to restore the abdominal wall in the midline. The anterior rectus fascia along with the rectus muscles are approximated in the midline with a simple running number 1 Stratafix suture. Then, a piece of ProGrip mesh is cut to size, placed in the retrorectus space, and centered over the midline. The posterior rectus sheath along with the peritoneum is closed using a simple running suture.
Discussion: This approach provides many benefits. The patient now has restoration of her midline abdominal wall, with an extraperitoneal piece of mesh that is not in contact with the abdominal viscera. Furthermore, the hernia sac is easily excised, and large tissue flaps are avoided, likely decreasing the rates of seroma formation and surgical site infections, respectively. Finally, we have avoided both double docking of the robot and having the need to place additional ports. Future studies using this approach will help to prove these benefits.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79165
Program Number: V171
Presentation Session: Video Loop
Presentation Type: VideoLoop
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