Robotic preperitoneal lateral hernia repair: technical tips and pitfalls

Lateral hernias are uncommon abdominal wall defects that pose significant surgical challenges due to their unique anatomy and limited published data guiding repair methods. This study aims to evaluate the feasibility and short-term outcomes of a robotic assisted minimally invasive approach for lateral hernia repair.

A single-institution, retrospective case series was conducted with 15 patients who underwent robotic preperitoneal lateral hernia repair. Demographics, operative considerations, and short-term outcomes were recorded and analyzed.

The median age was 65 years, 73% were females (n = 11), and median body mass index was 29 kg/m². American Society of Anesthesiology classes were 3 (n = 11; 73%) and 2 (n = 4; 27%). Most hernias were incisional (n = 10), with traumatic (n = 2), and superior lumbar (n = 2) comprising the remainder. Left sided (n = 13) hernias were more common than right (n = 2). Two were recurrent with prior mesh. Median defect length and width were 7 and 9 cm, respectively. Median operative time was 199 min, and median blood loss was 20 mL. Median follow-up time was 180 days. Of the 12 cases who returned for follow-up, there was 1 (8%) recurrence, 1 (8%) reoperation and readmission after 30 days. The most frequent 30-day complication was a self-resolving seroma. (n = 3.20%), and no mortalities were observed.

Our case series of 15 patients indicates robotic-assisted lateral hernia repair as a feasible approach with acceptable short and mid-term outcomes, though interpretation is limited by small sample size and variable follow-up. Preoperative imaging and in-depth knowledge of lateral anatomy proved essential for optimizing outcomes.