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Robotic retromuscular abdominal wall repair using an inverted TEP (iTEP) approach: surgical technique and short-term outcomes

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Abstract

Purpose

Robotic retromuscular abdominal wall repair (RAWR) for ventral hernias can be performed transabdominal or extraperitoneal by using an enhanced view totally extraperitoneal repair (eTEP). For defects in the meso- or epigastric region, an inverted approach can be used, starting the development of the totally extraperitoneal plane in the suprapubic region and progressing in a caudal-to-cranial direction (inverted TEP, iTEP). The aim of the study is to present the surgical technique and to report the short-term outcomes.

Methods

A retrospective analysis of a prospectively maintained database was performed, including patients who underwent a robotic RAWR using the iTEP approach between December 2019 and January 2022. The surgical technique was described, and patients’ characteristics and intra- and postoperative parameters were studied and compared to the TARUP technique (robotic transabdominal retromuscular umbilical prosthetic hernia repair).

Results

Thirty-four patients were treated with an iTEP approach, and 14 patients underwent a TARUP procedure. The median length of stay was 1 day (range 1–3), and there were no intraoperative complications in both groups. One patient (3%) required reoperation after an iTEP approach for a small bowel internal herniation due to a rupture of the posterior rectus sheath. There were no recurrences or mortality with a median follow-up of 15 months (range 3–29) in the iTEP group, compared to 35 months (range 29–37) in the TARUP group.

Conclusion

For defects in the upper abdominal region, a robotic RAWR with an iTEP approach appears to be safe and feasible. Long-term follow-up is needed to evaluate the late recurrence rate.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of General and Abdominal Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium

    Frederick Olivier, Mohamed Abasbassi & Joachim Geers

Authors
  1. Frederick Olivier
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  2. Mohamed Abasbassi
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  3. Joachim Geers
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Contributions

Study conception and design: FO, MA, and JG; acquisition of data: FO, MA, and JG; analysis and interpretation of data: FO, MA, and JG; drafting of manuscript: FO, MA, and JG; critical revision of the manuscript: FO, MA, and JG.

Corresponding author

Correspondence to Frederick Olivier.

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Ethics approval

All procedures performed in this study involving the patients were in accordance with the ethical standards of the institutional and the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The medical ethics committee of our institution waived the need for a review of the study due to its observational and retrospective nature.

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Not applicable.

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Not applicable.

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The authors declare no competing interests.

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Supplementary file1 Vid 1. The key steps of the robotic retromuscular abdominal wall repair using the iTEP-approach (MP4 448231 kb)

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Olivier, F., Abasbassi, M. & Geers, J. Robotic retromuscular abdominal wall repair using an inverted TEP (iTEP) approach: surgical technique and short-term outcomes. Langenbecks Arch Surg 407, 2177–2186 (2022). https://doi.org/10.1007/s00423-022-02561-1

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  • DOI: https://doi.org/10.1007/s00423-022-02561-1

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