, Volume 22, Issue 5, pp 837–847 | Cite as

Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair

  • I. BelyanskyEmail author
  • H. Reza Zahiri
  • Z. Sanford
  • A. S. Weltz
  • A. Park



The enhanced-view totally extraperitoneal (eTEP) hernia repair technique was first described for laparoscopic inguinal hernia repair and later applied to laparoscopic ventral and incisional hernia repair. We present our center’s early operative outcomes utilizing principles of this technique during robotic ventral and incisional hernia repair for implementation of the robotic eTEP Rives–Stoppa (eRS) and eTEP transversus abdominis release (eTAR) techniques.


A review of a prospectively maintained database of hernia patients was conducted identifying 37 patients who underwent robotic eTEP for ventral, incisional, flank or parastomal hernia repair between March and October 2017. All patients underwent retrorectus dissection with selective utilization of transversus abdominis release (TAR) as indicated.


37 patients including 13 male and 24 female with mean age, body mass index, and ASA score of 54, 35.5, and 2.4, respectively, underwent a mean operation room time of 198 min. Mean length of stay was 0.7 days. There were no intraoperative complications. Two patients developed subcutaneous seromas requiring interventional radiology drainage. One patient was readmitted at 30 days for PO intolerance that was managed expectantly. Mean postoperative follow-up visit occurred at 36 days with no sign of early hernia recurrences.


The enhanced-view totally extraperitoneal approach is both safe and feasible in robotic-assisted repair of ventral and incisional hernias. Although long-term outcomes and patient selection criteria require further study, we believe this technique will become an important tool in the armamentarium of minimally invasive hernia surgeons.


Hernia Ventral hernia Incisional hernia Robotic hernia surgery Extended-view totally extraperitoneal eTEP eRS eTAR AWR Abdominal wall reconstruction 



Figures are reprinted from “Robotic Extended-View Totally Extraperitoneal Access Rives-Stoppa Repair”, by Belyansky I, Sanford Z, Weltz AS, Zahiri HR, 2018, Atlas of Robotic Surgery. Copyright (2018) by Ciné-Med, Inc.

Compliance with ethical standards

Conflict of interest

Dr. Igor Belyansky's disclosures are honoraria and consulting fees from Intuitive, Bard, Medtronic, and Allergan. Drs. H. Reza Zahiri, Zachary Sanford, Adam S. Weltz, and Adrian E. Park have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

All authors certify that they accept responsibility as an author and have contributed to the concept, data gathering, analysis, manuscript drafting, and give their final approval.

Supplementary material

10029_2018_1795_MOESM1_ESM.tif (1.7 mb)
Supplementary material 1 A B C D: Introduction of the 5-mm laparoscope into the retrorectus space (TIF 1753 KB)
10029_2018_1795_MOESM2_ESM.tif (1.6 mb)
Supplementary material 2 A B C D: Sequence of port placement in lower midline defect repair (TIF 1592 KB)
10029_2018_1795_MOESM3_ESM.tif (27 mb)
Supplementary material 3 Robotic division of the posterior rectus sheaths (TIF 27616 KB)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • I. Belyansky
    • 1
    Email author
  • H. Reza Zahiri
    • 1
  • Z. Sanford
    • 1
  • A. S. Weltz
    • 1
  • A. Park
    • 1
    • 2
  1. 1.Department of SurgeryAnne Arundel Medical CenterAnnapolisUSA
  2. 2.Johns Hopkins University School of MedicineBaltimoreUSA

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