title: Totally extraperitoneal (TEP) bilateral hernioplasty using the Single Site® robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results.
abstract: Laparoendoscopic single site totally extraperitoneal (TEP) hernia repair showed to be a feasible alternative to conventional laparoscopic hernia repair; nevertheless single site surgery, with the loss of instruments triangulation can be a demanding procedure. To overcome those hurdles, the Single Site® (SS) platform of the da Vinci (DV) Si robotic system enables to perform surgical procedures through a 25-mm skin incision, with a stable 3D vision and restoring an adequate triangulation of the surgical instruments. We present in details the technique and the preliminary results of DV-SS TEP, to our knowledge the first cases reported in literature.
  
  
  
  In March 2016, three consecutive male patients (mean age 46.6 years-mean BMI 25.3) with bilateral symptomatic inguinal hernia were submitted to DV-SS TEP in our institutions. Feasibility, codification of the technique, operative time and perioperative outcomes were recorded.
  
  
  
  All the procedures were completed as scheduled, with no conversion to other techniques. Mean operative time was 98.6 min, ranging between 155 and 55 min, reflecting the learning curve of the operating room team on this new procedure. No intraoperative or postoperative complications were experienced and all the patients were discharged within 24 h after surgery. Patients reported satisfactory postoperative course, with no recurrence of inguinal hernia and satisfaction in cosmetic result at 6-month follow-up.
  
  
  
  DV-SS TEP inguinal hernia repair showed to be feasible and effective surgical option for bilateral groin hernia repair. Patients' outcome was uneventful, with optimal cosmetic results. Further studies comparing this innovative technique to TEP or LESS TEP should be promoted.
authors.affiliation: Department of Urology-Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Via Mercalli 28/30, 20122, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cestari
authors.affiliation: Department of Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Galli
authors.affiliation: Department of Urology-Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Via Mercalli 28/30, 20122, Milan, Italy.
authors.forename: M N
authors.initials: MN
authors.lastname: Sangalli
authors.affiliation: Department of Urology-Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Via Mercalli 28/30, 20122, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zanoni
authors.affiliation: Department of Urology-Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Via Mercalli 28/30, 20122, Milan, Italy. em.ferrari@alice.it.
authors.forename: M
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Department of Surgery, IRCCS Istituto Auxologico Italiano, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Roviaro
mesh_terms: D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065287:Robotic Surgical Procedures
keywords: Da Vinci; Inguinal hernia; LESS; Robotic surgery; Single site surgery; TEP