First experience in Spain of large ventral hernia treated with botulinum toxin combined with robot-assisted...

We present the first documented case in Spain of a large midline incisional hernia treated with botulinum toxin A (Botox A) in conjunction with robot-assisted transversus abdominis release utilising the Hugo robot-assisted surgery (RAS) by Medtronic (Minneapolis, MN, USA). The patient, a woman in her late 40s, was referred to our outpatient clinic due to two significant midline incisional hernias which were causing abdominal discomfort and constipation. Her medical history included a laparoscopic myomectomy that had been converted to open surgery, resulting in a sub-umbilical incision. This led to the development of a double-component midline incisional hernia: one at the umbilical level (site of laparoscopic access) and another located over the incision from the laparotomic conversion. Six weeks prior to surgery, we conducted preoperative ultrasound-guided electromyographic injections of Botulinum Toxin A into the lateral abdominal wall muscles. The surgical procedure lasted 450 min, during which there were no conversions or intraoperative complications. The robotic system was docked twice, once for each side, with a total docking time of thirty minutes. The patient's hospital stay extended to 4 days. In conclusion, our findings indicate that the combination of Botox A and robot-assisted transversus abdominis release utilising the Hugo RAS system is a safe and effective treatment option.