1. Introduction

a. Insert 8-mm Optical Trocar

b. Insufflate the Abdomen

c. Inject Marcaine for Ilioinguinal Nerve Block

d. Insert 8-mm Lateral Trocars

2.Surgical Approach and Placement of Ports

3. Mesh Preparation

4. Dock Robot

a. Inspect Anatomy

b. Dissect Peritoneal Flap Inferomedially

c. Expose the Midline Pubic Symphysis

d. Dissect Preperitoneal Flap Inferolaterally

5. Dissection

a. Develop a Groove Medial to the Iliac Vein

b. Separate Peritoneal Sac from Cord Structures

c. Parietalize Vas and Spermatic Vessels

6. Right Hernia Sac Dissection

a. Nerve Identification

7. Posterosuperior Peritoneal Dissection

8. Lipoma of the Cord Dissction

9. Left Preperitoneal Flap Dissection

10. Left Hernia Sac Dissection

11. Obtain and Verify Critical View of the Myopectineal Orifice

12. Mesh Placement

13. Closure

14. Post-op Remarks

There are over 1 million hernia repairs performed annually in the US.  Robotics is revolutionizing the adoption of minimally-invasive hernia repairs lately.  For 20 years, in spite of the literature supporting the benefit of laparoscopic minimally-invasive repairs, only 25-30% of all hernias were performed laparoscopically. From 2015 to 2018, robotic laparoscopic hernia repairs have explosively grown from less than 2% to 20% of all hernia repairs performed in the US. Hernia repairs are among the most basic procedures for general surgeons, and there is substantial enthusiasm on the part of surgeons regarding the rapid changes in techniques as well as the best methods of teaching them. Surgical training programs may find it difficult to maintain training for their residents and fellows in the face of rapidly evolving technology. Therefore, we present the case of a 28-year-old male with bilateral inguinal hernias that were repaired using a robotic-assisted laparoscopic approach.

2. Surgical Approach and Placement of Ports

Watch this full-length, narrated surgical video of a robotic-assisted laparoscopic (rTAPP) bilateral inguinal hernia repair with mesh performed by Dr. David Lourie at Huntington Memorial Hospital

Huntington Memorial Hospital