title: Robot-Assisted Transabdominal Preperitoneal Ventral Hernia Repair.
abstract: OBJECTIVE
  We believe that complications due to the mesh used in ventral hernia repairs can be reduced by using the natural barrier afforded by the peritoneum. This can be challenging to do laparoscopically, however we felt that the robot-assisted laparoscopic approach reduces the difficulty in placing the mesh in the preperitoneal space, and we want to share our early experiences with this approach. We describe the surgical technique used in robot-assisted laparoscopic transabdominal preperitoneal (TAPP) ventral hernia repair with mesh. In addition, we evaluate its feasibility and present preliminary perioperative results.
  
  
  METHODS
  We performed robot-assisted laparoscopic TAPP ventral hernia repairs in 3 patients in the spring of 2015. Demographic information and defect size were measured. Conversion from a laparoscopic to an open procedure was the primary outcome variable.
  
  
  RESULTS
  There were 3 cases of robot-assisted TAPP ventral hernia repair with mesh. The mean age of the patients was 49 years, the mean body mass index was 32.6 kg/m(2), and the mean operative time was 163.7 minutes. The mean defect size was 1219.0 mm(2). There were no conversions to open during this early learning phase. All patients were discharged home within the 24-hour postoperative period. No complications were noted during a mean follow-up of 3 months.
  
  
  CONCLUSIONS
  We present our early experience with robot-assisted TAPP ventral hernia repair. We note that because of improved ergonomics and wristed instrumentation, the robotic platform enabled creation of peritoneal flaps and complete coverage of mesh with peritoneum after primary closure of the defect. The robotic approach is feasible and may provide a better environment for mesh integration and protection. Further investigations with long-term follow-up are needed to verify that this technique is effective in reducing mesh-related intra-abdominal complications.
authors.affiliation: Department of Surgery, State University of New York, Downstate Medical Center, Brooklyn, Brooklyn, New York, USA.
authors.forename: Gainosuke
authors.initials: G
authors.lastname: Sugiyama
authors.affiliation: College of Medicine, State University of New York, Downstate Medical Center, Brooklyn, Brooklyn, New York, USA.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Chivukula
authors.affiliation: Department of Surgery, State University of New York, Downstate Medical Center, Brooklyn, Brooklyn, New York, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
authors.affiliation: Department of Surgery, State University of New York, Downstate Medical Center, Brooklyn, Brooklyn, New York, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Alfonso
mesh_terms: D000328:Adult; D061887:Conversion to Open Surgery; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods*; D013526:Surgical Mesh
keywords: Herniorrhaphy; Laparoscopy; Robotic TAPP; Robotic herniorrhaphy; Ventral hernia