Recurrent Complex Inguinal Hernia: Robotic Tapp

Background Inguinal hernia is a prevalent pathology that the only definitive treatment is a surgical approach. Many techniques were described but minimally invasive surgery (MIS) is the most recommended. Despite this recommendation, patients that present a recurrent inguinal hernia become very complex to approach with MIS. A robotic approach has emerged as an ideal option to perform this type of case. We present a video of a recurrent complex left inguinal hernia using a Da Vinci robotic approach. This patient had a previous Nyhus approach and a second surgical revision because of a great postoperative hematoma. Method A Veress needle was used to create the neumoperitoneum. After that, an 8 mm robotic trocar was introduced just above the belly bottom, then 2 equidistant 8 mm trocars on the right and another one on the left were placed. The trocars were numbered 1, 2, 3 and 4 from the left to the right. The number 4 was used to pull the tissue and to expose the defect. Number 1 was used for the bipolar fenestrated, number 2 for the camera and number 3 for the scissors and needle driver. Results After a partial dissection of the hernial sac, a big defect was found. The remaining sac was sutured to decrease the cavity. A 15 × 20 cm Dynamesh IPOM was placed and fixed in Cooper´s ligament and the rectus muscle. Finally, the peritoneum was closed using a 2–0 barbed suture. Conclusion MIS using a robotic platform is feasible, ergonomic and it allows to reconstruct and repair very complex inguinal hernias.