Robotic Subcostal Hernia Repair: Totally Extraperitoneal (TEP)

Abstract

Subcostal hernias are atypical hernias, which may be difficult to repair using traditional methods such as open onlay repair. The difficulty is mainly due to the proximity of the hernia to the costal margin, which limits the space needed for adequate defect closure, mesh fixation, and mesh overlap. Minimally invasive subcostal hernia repair can be achieved with both intraperitoneal and extraperitoneal mesh placement techniques. Although the intraperitoneal onlay mesh (IPOM) technique is commonly adopted for a variety of midline hernias, the repair of subcostal hernias may prove challenging with an intraperitoneal approach because of their proximity to vital structures, especially at the stage of mesh fixation.