Robotic eTEP inguinal hernia repair

We evaluated the feasibility and safety of a robotic approach to the enhanced-view totally extraperitoneal (eTEP) technique for inguinal hernia repair, building on the foundational work by Jorge Daes. With the rise of robotic surgery, the "enhanced view" concept has transformed abdominal wall hernia repair. We present our center's experience applying e-TEP principles in robotic inguinal hernia repairs.

A prospective review was conducted of patients who underwent robotic e-TEP inguinal hernia repair from August 2023 to August 2024 at a single institution. Demographic data and EURA QS quality of life scores were collected. All patients underwent complete extraperitoneal dissection, including arcuate line or transversalis fascia division and critical view of the myopectineal orifice. No combined ventral hernias were included.

Thirty-six patients underwent robotic e-TEP repair. Median age was 68 years, median BMI 25.7, and 30.6% had prior abdominal surgery. Of hernias, 88.9% were primary and 11.1% recurrent. Hernia types included type 1 (55.6%), type 2 (44.4%), and type 3 (22.2%). Bilateral repair was performed in 5.6%. median operative time was 61 min (IQR: 49-74). Postoperative quality of life showed significant improvements in pain, activity restriction, and cosmesis (p < 0.001), with greatest improvement in activity restriction. Surgical site occurrences included seromas in 2 patients. No hematomas, recurrences, or major complications occurred; one conversion to r-TAPP was necessary.

The r-eTEP approach overcomes limitations of robotic TEP by enhancing extraperitoneal space development, visualization, and maneuverability. It offers favorable perioperative outcomes and represents a promising, safe, and effective alternative for inguinal hernia repair.