Safety and Patient-Reported Outcomes After Suprapubic eTEP Robot-Assisted Repair of Rectus Diastasis: A Single-Center Cohort Study

Background Postpartum rectus diastasis is common and may cause pain, core instability, functional impairment, and poor body image. Indications for surgical repair remain controversial. Minimally invasive and robotic techniques, including robotic-assisted eTEP suprapubic approach, expand options, but high-quality data on safety and patient-reported outcomes (PROMs) are limited. This study aimed to evaluate postoperative outcomes, safety, and patient-reported quality of life after robotic-assisted repair. Aims Assess safety, operative outcomes, complications, and patient-reported outcomes after robotic-assisted eTEP suprapubic repair. Methods All consecutive patients undergoing robotic-assisted repair of postpartum rectus diastasis with an eTEP suprapubic approach and retromuscular or preperitoneal mesh placement at a single center between 2018 and 2025 were retrospectively analyzed. Postoperative clinical outcomes and follow-up data were systematically reviewed. All patients completed validated PROMs, including the EuraHS-QoL, SF-36, and a Body Image Questionnaire. Primary endpoint was postoperative safety; secondary outcomes included operative time, complications, length of stay, and PROMs at follow-up Results Thirty-seven female patients were included; median age 42 years (IQR 38–47), ASA 2 (62%), median BMI 23.4 kg/m² (IQR 21.9–25.8). Median pregnancies: 2; pain was the main indication (78%). Concomitant hernias were present in 30 (81%) and repaired concurrently. Median operative time 189 min (IQR 165–215), hospital stay 3 days (IQR 2–4). Preoperative diastasis 55 mm (IQR 45–70), reduced to ≤5 mm (IQR 0–10) postoperatively. Mesh was used in all cases (median 20 × 10 cm, IQR 18 × 10–25 × 12 cm). Five patients (13.5%) had complications; one major (Clavien–Dindo IIIb) required reintervention. Median follow-up 18 months (IQR 12–30), 89% follow-up rate; no recurrences. PROMs showed low pain, minimal functional limitation, good physical function, and high body image satisfaction. Conclusion Robotic eTEP suprapubic repair of postpartum rectus diastasis with retromuscular/preperitoneal mesh and hernia repair appears safe, with low morbidity and favorable patient-reported outcomes