Robotic assisted TAPP bilateral obturator, right femoral and inguinal hernia repair with mesh in an elderly patient by Dr Iraniha.
This is a 91 year old female with history of a bulge in the right groin with on and off pain and discomfort and episodic abdominal pain. She underwent a diagnostic laparoscopy surgery which showed bilateral obturator, right femoral and inguinal hernias. Therefore, a robotic surgery assisted of her hernia repair with placement of 3 D mesh was carried out. 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. The enhanced visualization and superior wristed instrumentation of the robotic surgery platform allowed the more precise dissection in this region.
The hernia sacs were reduced from the hernia defects including bilateral obturator hernias 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 all defects. Special medical adhesive was sprayed to facilitate the attachment of the mesh to the abdominal wall for the hernia repair.
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 hernia surgery. Patient went back to normal activity soon after the surgery with no pain. This hernia repair video demonstrates the feasibility and safety of the robotic surgery assisted obturator hernia repair even in the elderly population.