Complex Traumatic Diaphragmatic Hernia Repair with the Robotic Platform

Ealaf Shemmeri, MD

Product Details
Product ID: ACS-6006
Year Produced: 2020
Length: 9 min.


We present a case of a 36 year old male with a remote history of motor vehicle accident, presenting with acute right upper quadrant pain. Imaging showed a right diaphragmatic hernia containing the left lobe of the liver, gallbladder, right colon and appendix. His symptoms self-resolved and he was brought back for elective repair. We opted for robotic abdominal approach for better visualization of the retrohepatic vena cava and minimal incisional pain burden to the patient. We commenced with lysis of adhesions off the anterior lip of the defect. With meticulous eversion of the diaphragm, we reduced the majority of the hernia, leaving the liver for last. Using a combination of hernia eversion and valsalva maneuver to push the liver into the abdomen, we were able to fully reduce it. Once the liver was reoriented in normal anatomic position, we proceeded to release the posterior portion of the defect from adhesions, taking care to identify the hepatic vein posterior to our cautery. The defect was then primary closed with figure of eight pledgetted sutures. A proline mesh was used to reinforce our repair. The patient was discharged home on postoperative day 2 tolerating a regular diet. In conclusion, robotic repair of a complex diaphragmatic hernia can be achieved via the abdominal approach. The main principals are to release the diaphragmatic adhesions, with slow eversion to expose the thoracic component, valsalva maneuver to push contents into the abdomen, and consistently identify the retrohepatic venous structures to avoid catastrophic injury.