Robotic Transabdominal Preperitoneal Inguinal Hernia Repair

Abstract

Despite the well-established benefits in minimally invasive (MIS) inguinal hernia repairs, it is only offered by a minority of surgeons in the United States with adoption rates ranging between 14 and 19% (Rutkow, Surg Clin North Am 83:1045–51, 2003; Smink et al., J Laparoendosc Adv Surg Tech A 9: 745–8, 2009). Many attribute low penetration rates as a testament to the difficulty of understanding the anatomy of the retroinguinal space. There has been a rapid adoption of robotic inguinal hernia repair in the armamentarium of general surgeons across the United States. Surgeons boast the enabling quality of the robotic instrument in terms of visualization, tremorless precision and articulation of the instrumentation, and improved ergonomics (Stoikes N, et al, Surg Technol Int XXIX:119–22, 2016).

This chapter will introduce the concept of the critical view of the myopectineal orifice. Common questions including but not limited to extent of preperitoneal dissection, rules of fixation, and minimum mesh size will be addressed by this mandate and cover all approaches be it laparoscopic TEP/TAPP or rTAPP. The authors suggest and conclude that mesh should not be placed prior to confirming the critical view of the MPO.

This chapter utilizes the well-established principles of conventional laparoscopy to describe the robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair technique.