1. Introduction

2. Surgical Approach and Placement of Ports

3. Robot Docking

4. Exposure and Taking Down Attachments

5. Creation of Peritoneal Flap and Reduction of Hernia Sac

6. Primary Closure of Hernia Defect

7. Mesh Placement

8. Closure of Peritoneal Flap over Mesh

9. Robot Undocking

10. TAP Blocks

11. Closure of Port Sites

An umbilical hernia occurs due to weakened umbilical fascia or at the site where the involuted umbilical vessels exited. Depending on the hernia contents—preperitoneal fat, omentum, or small intestine—symptoms may include a new bulge at the umbilical site, abdominal pain, tenderness to palpation, color changes to the surrounding skin, as well as obstructive symptoms such as nausea, emesis, and constipation. Given that umbilical hernias tend to have narrow necks compared to size of the sac, incarceration and strangulation are relatively common. Elective repair of symptomatic umbilical hernias is done to minimize these risks. Here we present the case of an 81-year-old male with a recurrent umbilical hernia who first presented secondary to obstructive symptoms caused by an incarcerated umbilical hernia. After reduction was successful, he underwent an elective robotic transabdominal (rTAPP) umbilical hernia repair with intra-abdominal preperitoneal underlay mesh (IPUM). This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

Watch this full-length, narrated surgical video of a robotic-assisted laparoscopic (rTAPP) umbilical hernia repair with intra-abdominal preperitoneal underlay mesh (IPUM) performed by Dr. Charu Paranjape at Newton-Wellesley Hospital.

Newton-Wellesley Hospital