1. Introduction

2. Ultrasound-Guided Marking, Bilateral TAP Blocks, and Right Rectus Block

a. Left Rectus Block

3. Access to the Left Retrorectus Space and Placement of Ports

4. Robot Docking

5. Ipsilateral (Left) Retrorectus Space Dissection and Identification of Linea Alba

6. Enter Preperitoneal Space Through Posterior Rectus Sheath and Take Down Preperitoneal Fat and Hernia Sac

7. Contralateral (Right) Retrorectus Space Dissection

8. Summary of Dissection

a. Posterior Peritoneal Defect

b. Anterior Fascia

c. Anterior Fascia with Image Inversion

9. Fascia Closure

10. Mesh Preparation

11. Mesh Placement

12. Closure

13. Post-op Remarks

Minimally invasive repair for ventral and incisional hernias has rapidly improved over the last years, mostly due to the introduction of new robotic techniques. With the introduction of the robotic extended view totally extraperitoneal repair (eTEP), which combines the best aspects of laparoscopic and open surgery without the disadvantages of either, minimizing entry into the abdominal cavity is now possible. With robotic eTEP retrorectus hernia repair, the robotic ports are placed directly into the retrorectus space. Using the crossover technique, the retrorectus spaces are combined with a pre-peritoneal bridge of the peritoneum. The defects are closed robotically, and the mesh is placed within the retrorectus space. Here, we present the robotic eTEP retrorectus Rives-Stoppa repair of an upper midline primary ventral hernia in a 63-year-old female.


Watch this full-length, narrated, surgical video of a robotic eTEP recrorectus Rives-Stoppa repair for a ventral hernia performed by Dr. Rockson Liu at Alta Bates Summit Medical Center. 

Alta Bates Summit Medical Center