Novel "T-Incision" Method With Robotic-Assisted Transabdominal Preperitoneal Repair for Lateral Inguinal Hernia: An Operative Technique (With Video).

Abstract

<h4>Introduction</h4>Robotic-assisted transabdominal preperitoneal repair (R-TAPP) was first described in 2007. Since then, the procedure has gained increasing popularity, particularly in the United States, where its use surpassed laparoscopic repair in 2022. In Japan, R-TAPP is performed only under self-pay healthcare, but nationwide multicenter data have confirmed its safety and feasibility.<h4>Materials and surgical technique</h4>We developed a novel peritoneal incision method-the "T-incision"-to optimize exposure and facilitate mesh placement during R-TAPP for lateral inguinal hernia. This approach combines the advantages of linear and circular incisions. We describe the procedural details and provide step-by-step intraoperative images and video.<h4>Discussion</h4>Robotic platforms enable precise dissection in confined spaces. The T-incision balances surgical exposure and safety, improving mesh placement without excessive dissection. We believe this technique will help to standardize R-TAPP in Japan as the procedure becomes more widely implemented.