Introduction : Randomized controlled trials and nationwide databases have shown that minimally invasive ventral hernia repair decreases rates of surgical site infection and hospital length of stay with no impact on long-term outcomes of recurrence when compared to open surgery. Robotic herniorrhaphy is a minimally invasive technique that facilitates the evidence-based benefit of fascial closure at the time of repair. In addition, there are theoretical advantages to this approach including preperitoneal placement of mesh and reduced points of mesh fixation. Given the cost associated with robotic surgery, patient selection is critical. For this presentation, we demonstrate a robotic transabdminal preperitoneal (rTAPP) umbilical herniorrhaphy in a patient meeting our institution's selection criteria for robotic repair.

Video Description: Once pneumperitoneum is obtained, the intraabdominal contents and anterior abdominal wall are examined. An incision is made in the peritoneum at a distance approximately 10 cm from the hernia. A wide preperitoneal pocket is developed and extended across the midline to the preperitoneal space on the opposite side. As we approach the midline, two defects are noted - one at the umbilicus and another within the epigastrium. Each hernia is dissected circumferentially and the contents reduced. The defects are closed primarily with 0 barbed suture. The preperitoneal space is measured and a piece of self-gripping, macroporous polyester mesh is placed within this space. The peritoneum is closed over the mesh using a 0 barbed suture in running fashion. Lastly, the peritoneal flap is inspected and residual defects are closed primarily using 3-0 vicryl suture.