Large Sliding Left Inguinal Hernia
This is a 65 year old male with history of a bulge in the left groin with on and off pain and discomfort during straining and heavy activity. Patient underwent a robotic assisted repair of inguinal hernia with placement of 3 D mesh. Patient was taken to the operating room and underwent a general anesthesia and placed in the lithotomy position. A 12 mm trocar was inserted in the supraumbilical location and camera was inserted. Then two 8 mm robotic trocars were placed on the right and left upper abdomen and the robotic arms were ducked in and instrument were placed. There was an evidence of large indirect sliding hernia containing part of the sigmoid colon.
Large Sliding Left Inguinal Hernia Surgery
The surgery was started with creating a transverse peritoneal incision from the anterior superior iliac spine towards the medial umbilical ligament and pre-peritoneal space was entered and peritoneal flap was created. Attention was taken to protect the large bowel. The enhanced visualization and superior wristed instrumentation of the robotic platform allowed the more precise dissection in this region. The large and very complex hernia sac was reduced from the hernia defect and the dissection carried in four directions to create a pre-peritoneal space for placement of the mesh. The anatomic landmarks were identified. A 3 D mesh was inserted and placed in the pre-peritoneal space to cover the defect. Special medical adhesive was sprayed to facilitate the attachment of the mesh in position. The peritoneal defect was then closed. Patient was discharged in the same day and was followed up twice for six weeks with no complication or recurrence. The pain was reported as minimal, requiring pain medication for just a few days after the surgery. Patient went back to normal activity and heavy exercise six weeks after the surgery with no pain.