Robotic Transversus Abdominis Release
The transversus abdominis release (TAR) includes a wide lateral dissection, preservation of perforating nerves and vessels to the anterior abdominal wall, and medial advancement of both posterior and anterior fascial layers for re-creation of the linea alba. It reduces the risk of wound complications and reduces the risk of developing lateral hernias compared to other posterior component separation techniques. The TAR provides excellent space for mesh placement in order to reinforce the visceral sac and is applicable to many patients and many hernias. Traditionally the TAR has been an open procedure, requiring a large midline laparotomy incision and multiple-day hospital stays, but within the last few years, it has been found to be feasible, although technically difficult, to complete a TAR laparoscopically or endoscopically. The adoption and increased utilization of surgical robotics has allowed minimally invasive TAR to become much more widespread as the dissection and suturing are much less technically challenging with the EndoWrist® technology of the robot, as well as improved visualization.
KeywordsRobotic surgery Hernia Abdominal wall reconstruction Posterior component separation Ventral hernia Myofascial release Incisional hernia Retromuscular Preperitoneal
- 3.Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB. Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg. 2016;264(2):226–32. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-900000000-97031 CrossRefGoogle Scholar
- 10.Sugiyama G, Chivukula S, Chung PJ, Alfonso A. Robot-assisted transabdominal preperitoneal ventral hernia repair. JSLS J Soc Laparoendosc Surg. 2015;19(4):e2015.00092. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756357/ CrossRefGoogle Scholar
- 12.Ballecer C. Robotic ventral hernia repair. In: Novitsky YW, editor. Hernia surgery: current principles. Cham: Springer International Publishing; 2016. p. 273–86.Google Scholar
- 14.Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, et al. Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg. 2017. Available from: http://insights.ovid.com/crossref?an=00000658-900000000-96161
- 15.Majumder A, Fayezizadeh M, Neupane R, Elliott HL, Novitsky YW. Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair. J Am Coll Surg. 2016. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1072751516001903