Robotic Extended Totally Extraperitoneal (eTEP) Ventral Hernia Repair

The super specialty of complex abdominal wall reconstruction continues to evolve based on advanced techniques built upon the shoulders of those who created the initial stages of component separation at the end of the twentieth century. With the advent of technological advances such as robotic surgery, a refined approach has been developed which allows for bilateral myocutaneous flaps creation from an extraperitoneal plane, specifically preperitoneal, known as the extended preperitoneal (eTEP) approach. The robotic platform offers numerous ergonomic advantages to the surgeon which allow for performance of a complex reconstruction of the abdominal wall with attention to detail in all aspects of hernia repair including dissection of the hernia sac and reduction of the hernia contents, a primary repair of the defect under minimal or no tension, plication of associated rectus diastasis, and mesh implantation as a preperitoneal/retrofascial/retromuscular sublay. This SOC will illustrate the robotic extended totally extraperitoneal (eTEP) approach for ventral hernia repair with plication of associated rectus diastasis as a useful adjunct to the minimally invasive surgeon’s toolset and the most recent novel technique for complex abdominal wall reconstruction.