Robotic Assisted Totally Extraperitoneal Incisional Hernia Repair With Posterior Component Separation After Orthotopic Liver Transplantation

Abstract Aim Incisional hernia is a common complication following liver transplantation. Open repair remains the standard of care, due to the fear of adhesions and complications. Recently, some groups published a series of minimally invasive approaches. However, most of them were laparoscopic approaches with intraperitoneal mesh placement with potential complications. The robotic-assisted extended extraperitoneal approach (r-eTep) could be a feasible and safe way to treat the hernia. Methods We present a case of a 64-year-old male patient submitted to an orthotopic liver transplantation. One year after the procedure he developed a large incisional hernia in the midline and right upper quadrant. The hernia classification was M1-3, L 2, W 3 (15 × 20 cm). After clinical optimization, the patient was taken to the OR for a r-eTep repair of his hernia. Results We begin the procedure by the left quadrant of the abdomen, creating a extraperitoneal space. Three trocars of the robot are placed. The extraperitoneal space is then dissected showing the midline hernia and part of the lateral. A posterior component separation with transversus abdominis release (TAR) is done. After the complete dissection, the abdominal wall is closed and the mesh is placed. The procedure lasted 170 minutes. There were no complications. Length of stay was 2 days. There is no recurrence in a period of 2 years. Conclusion R-etep with TAR is feasible and safe in patients with incisional hernia after liver transplantation. This video shows our standardization in a patient with good post-operative results.