Robotic Repair of Upper Abdominal Hernias

Abstract

Upper abdominal wall hernias are uniquely challenging due to the anatomic limitations of the costal margin and abdominal muscular insertions to the lower ribs and xiphisternum. This can impair the capacity to close larger defects, and limits the ability to fixate mesh superiorly when placed in a sublay position. The robotic platform may be ideal for repair of these hernias. Superior three-dimensional imaging and articulating instrumentation overcome many of these obstacles by allowing complex dissection of the abdominal wall compartments to facilitate defect closure and extraperitoneal sublay placement of mesh. This chapter describes robotic techniques for repair of hernias in the upper abdomen.

Glossary

Rives-Stoppa

Technique for ventral hernia repair involving myofascial release of both rectus muscles, mesh reinforcement in the retromuscular space and defect closure over the mesh.

Transversus abdominis release (TAR)

A posteriorly oriented component separation by which the transversus abdominis muscle and fascia are divided within the posterior rectus sheath to release the lateral abdominal wall and allow midline fascia closure.