ROBOTIC RETROMUSCULAR ABDOMINAL WALL REPAIR USING AN INVERTED TEP (iTEP) APPROACH: RESULTS OF THE FIRST 100 PATIENTS

Abstract Background In 2022, our technique of robotic retromuscular abdominal wall repair (RAWR) for ventral hernias, using an inverted totally extraperitoneal repair (iTEP)-approach, was first described. Up until this day, this technique is used in the robotic treatment of all ventral hernias with rectus diastasis. The aim of the study is to analyse surgical outcomes and to report the results of the first 100 patients. Method A retrospective analysis of a prospectively maintained database was performed, including all consecutive patients who underwent a robotic RAWR using the iTEP-approach. Patients’ characteristics, intra- and postoperative parameters were studied. Follow-up time was calculated from the date of surgery up until study closure in January 2024. Results Between December 2019 and January 2024, 100 patients (female/male 39/61, median age 62 years, range 20–90) were treated using the iTEP-approach. In 58 patients (58%), the indication was an incisional hernia. Median operating time was 135 minutes (range 65–300). The median length of stay was 1 day (range 1–4). No intraoperative complications were observed. One patient (1%) required reoperation for a small bowel internal herniation due to a rupture of the posterior rectus sheath. In two patients (2%), conversion to a laparotomy was necessary due to extensive adhesions. There were no recurrences or mortality with a median follow-up of 14 months (range 0–49). Conclusion For defects in the upper abdominal region, a robotic RAWR with an iTEP-approach appears to be safe and feasible. Long-term follow-up is still needed to evaluate late recurrence rate.