ROBOTIC TOTAL EXTRAPERITONEAL (rTEP) INGUINAL HERNIA REPAIR: A PRAGMATIC APPROACH

Abstract Background There has been an evolution in inguinal hernia surgery from open, laparoscopic to the current robotic approach. A recently published meta-analysis supports robotic surgery as a safe, effective, and viable alternative for Inguinal hernia repair. Like laparoscopic hernia repair, robotic surgery has trans-abdominal preperitoneal (rTAPP) and total extraperitoneal (rTEP) approaches. However, most of the studies are confined to the rTAPP approach, and there is minimal published data on the rTEP approach. Rationale A total extraperitoneal approach has various advantages, like non-violation of the peritoneal cavity, less chances of paralytic ileus, and lower seroma formation and infection. However, multiple difficulties exist in performing rTEP inguinal hernia repair, creating the preperitoneal space, ergonomics, and the site of robotic port placement. Thus, most robotic surgeons perform rTAPP inguinal hernia repair. Novelty An extensive literature search found no resources for the rTEP surgical technique. Hence, we developed a method of rTEP inguinal hernia repair based on the experience of the laparoscopic TEP repair collaborated with the robotic surgery principles. Here, I present a video demonstrating the steps of rTEP inguinal hernia repair in a 47-year-old female patient with a left-sided direct inguinal hernia.