Using the Da Vinci Single Port Robotic Platform in Abdominal Wall Surgery: Preclinical Exploration of a Suprapubic Single Port Extraperitoneal Approach (SP<sup>2</sup> eTEP).

Abstract

<h4>Background</h4>The Da Vinci Single Port (SP) robotic platform has recently been approved for general surgery in the European Union. However, its application in abdominal wall hernia repair remains largely unexplored. This study focuses on the development of a novel suprapubic single-port extraperitoneal approach (SP² eTEP) for ventral hernia surgery.<h4>Method</h4>Following the IDEAL framework for introducing new surgical procedures, this study details the preclinical exploration and technical development of SP²eTEP using the Da Vinci SP system. The research included procedural development on human cadavers and skills training using a porcine model.<h4>Results</h4>Instrument reach and maneuverability were first evaluated using a silicone abdominal wall model. The model showed minimal reach loss between the 27 mm-SP metal cannula (29 cm straight, 27 cm articulated) and the collapsed SP small access port (28 cm straight, 26 cm articulated). Cadaveric sessions confirmed that the SP Access Port, placed suprapubically, allowed successful dissection in the preperitoneal, the retrorectus, and the subcutaneous planes. Additionally, bilateral component separation by transversus abdominis release was achieved using a bottom-up approach. The porcine model for inguinal hernia repair proved to be a suitable adjunct to simulator-based training for developing the necessary skills for subsequent clinical application.<h4>Conclusion</h4>This preclinical (pre-IDEAL stage) exploration and procedural development demonstrate the feasibility of SP² eTEP for ventral hernia repair with the Da Vinci SP platform. The findings support progression to clinical evaluation of this novel robotic approach for abdominal wall hernia repair.