Robotic enhanced-view totally extraperitoneal repair with endoscopic posterior linea alba reconstruction and retromuscular mesh for midline incisional hernias: a registry-based analysis of 40 consecutive patients

Laparoscopic incisional hernia repair offers advantages compared to open surgery. However, laparoscopic reconstruction of the linea alba is technically demanding. The robotic approach may facilitate this process. In this study, we present our experience with robotic enhanced-view totally extraperitoneal (eTEP) repair with endoscopic posterior linea alba reconstruction (EPLAR) for midline incisional hernias.

The robotic system da Vinci Xi® (Intuitive Systems, Sunnyvale, CA, USA) was used. Following preparation of the retromuscular space, EPLAR was performed using long-term absorbable barbed suture in a running fashion, and a macroporous nonresorbable synthetic mesh was introduced. Perioperative data were prospectively entered into the Herniamed registry. One-year follow-up was conducted using a standardized questionnaire.

From January 2022 to January 2024, robotic eTEP repair with EPLAR was performed in 40 patients (40% female) with incisional hernias. Hernia width was W1 (< 4 cm) in 37.5% of cases, W2 (4–10 cm) in 55%, and W3 (> 10 cm) in 7.5%. The mean operation time was 165.2 min. There were no intraoperative complications. The median length of hospital stay was 3 days (range 2–7 days). Postoperative complications occurred in 5 patients (one pulmonary embolism, one seroma, three cases of urinary retention). No reoperations were necessary. One-year follow-up was completed in 22 patients; there was no hernia recurrence and 82% of the patients were free of pain.

In our setting, robotic eTEP repair with EPLAR for midline incisional hernia treatment demonstrated favorable outcomes. There were few complications, no reoperations, and no recurrences at 1‑year follow-up. The robotic device provided the surgeon with the degrees of freedom necessary for endoscopic posterior linea alba reconstruction.