Short-term results of robot-assisted transabdominal pre-peritoneal repair for primary midline ventral hernias.

Abstract

<h4>Introduction</h4>Minimally invasive approaches are considered best for the repair of primary midline ventral hernia (PMVH). Mesh placement in the pre-peritoneal plane appears to be optimal with minimal disruption of normal anatomy. Robot-assisted surgery for the placement of mesh in the pre-peritoneal plane helps in overcoming the technical difficulties of the laparoscopic approach. We present our experience of robotic-assisted transabdominal pre-peritoneal (R-TAPP) approach for the repair of PMVHs and evaluate its feasibility and perioperative results.<h4>Patients and methods</h4>We performed R-TAPP for PMVHs between November 2023 and March 2025. Demographic data and hernia characteristics were noted. Operative data and post-operative complications were collected and analysed.<h4>Results</h4>A total of 67 patients underwent R-TAPP for PMVHs. Their average age was 45.85 years, body mass index (BMI) was 28.87 kg/m2, operating time was 81.19 min, defect size was 9.55 cm2 and five patients needed conversion to a robotic transabdominal retromuscular (R-TARM) repair. There were no conversions to laparoscopy or open procedure. Post-operative day 1 mean pain score was 1.78.<h4>Conclusion</h4>R-TAPP is safe and feasible in most cases of PMVHs with a short learning curve of approximately 20 cases. Conversion to R-TARM, through the same port positions, may be required in lower BMI patients. R-TAPP affords a good mesh-to-defect area ratio with mild post-operative pain. It has an acceptable perioperative and early post-operative complication profile.