Concurrent robotic trans-abdominal pre-peritoneal (TAP) herniorrhaphy during robotic-assisted radical prostatectomy

Robotic prostatectomy (RP) is now increasingly performed because it allows for precise dissection of neurovascular structures with better outcomes. It is estimated that 5-12% of candidates for radical prostatectomy have detectable inguinal hernias, and simultaneous mesh hernioplasty is now well supported. A disadvantage of radical prostatectomy is obliteration of the preperitoneal space of Bogros, which can make future totally extraperitoneal (TEP) herniorrhaphy difficult and prone to complication.

Four patients underwent RP using the DaVinci system. Six clinically detectable inguinal hernias were repaired. Upon completion of the prostatectomy, the peritoneum overlying the myopectineal orifice of Fruchaud was opened, the orifice was dissected free and the hernia reduced. A 3 x 6 inch polypropylene mesh or 4 x 6 inch polyester mesh was then affixed overlying the orifice with titanium tacks, and the peritoneum was closed over the mesh using a running absorbable suture.

The mean operating time for the TAP was 24 min. There were no postoperative complications. At a mean follow-up of 34 months, no recurrence was noted.

With the increasing incidence of RP, we advocate the concurrent repair of any detectable inguinal hernias at the time of prostatectomy. The preperitoneal placement of a polypropylene or polyester mesh secured with a tacking device and a peritoneal closure performed with a running absorbable suture is uniquely suited to the abilities of the robot, and provides a durable repair.