Robotic Triple Neurectomy for Postoperative Inguinal Pain

Background Postoperative chronic inguinal pain is a very catastrophic situation in a patient that underwent an inguinal hernia repair. The first step is to dismiss is a recurrent hernia exits. Then the patient is diverting to the pain unit in order to assess the use of drugs, infiltrations, rhizolysis or another treatment. If these procedures don´t work, a triple neurectomy is consider improving the pain. Literature defends the proximal neurectomy to have better results. We present a patient that was subjected to a robotic triple neurectomy approach because he continued with pain despite 3 hernioplasties and different treatments with the pain unit. Method A Veress needle was used to create the pneumoperitoneum. After that, an 8 mm robotic trocar was introduced just above the belly bottom, then 1 upward equidistant 8 mm trocar and another downward were placed. The trocars were numbered in 1, 2, 3 from the up to the down. The fourth arm was put away. Number 1 was used for the bipolar fenestrated, number 2 for the camera and number 3 for the scissors and needle driver. Results After peritoneal dissection of the myopectineal orifice (MPO), a plug mesh and direct defect were found. The MPO was dissected then we continued upward, and the parietal compartment was dissected to achieve the nerves. After a rigorous dissection a segment of the iliohypogastric, ilioinguinal and genitofemoral nerves were divided. A15 × 15 cm Dynamesh IPOM was placed in the MPO and fixed in the Cooper´s ligament. Finally, the peritoneum was closed using a 2–0 barbed suture. The patient revealed progressive decreasing of the pain after one month. Conclusion The excellent vision and manipulation of the robotic platform could improve our results in these complex cases.