Robotic Flank Hernia Repair

Abstract

Flank hernias represent a challenging entity for general surgeons, even for those with a busy hernia practice. While open and minimally invasive techniques exist for repair of flank hernias, the use of robotic-assisted repair makes dissection and suturing more precise and feasible compared to its laparoscopic counterpart. Patient expectations should be discussed preoperatively, as persistent bulging may still be present postoperatively despite adequate defect closure and mesh reinforcement due to underlying denervation from previous surgery or trauma to the area. The surgeon must decide whether a pre-peritoneal or intraperitoneal approach will be undertaken, as the dissection and mesh choice differ significantly between the two options. Following intracorporeal defect closure, the mesh is placed and fixated to ensure adequate overlap. Fixation may be completed with sutures as well as other forms of fixation including bone anchors for defects close to the bony pelvis. A high-quality robotic-assisted flank hernia repair can be very satisfying for the both the patient and surgeon alike. However, appropriate long-term follow-up should be pursued due to the inherent challenges that flank hernias and their repairs entail.