Robotic transabdominal pre-peritoneal repair of a bilateral inguinal hernia: a surgical technique displaying an...

Minimally invasive repair of inguinal hernias offers several advantages over the conventional open approach in the context of reduced postoperative pain and faster return to daily activities with a non-inferior recurrence rate. With the increasing adoption of robotic platforms in surgical units worldwide, robotic transabdominal pre-peritoneal (rTAPP) repair has become an increasingly popular option offered to the patients. Successful surgical outcomes for any minimally invasive inguinal hernia depend on thorough understanding of the internal landmarks of myopectineal orifice (MPO). A conceptual framework such as inverted Y or 5 triangles described by Furtado et al. is essential to be understood prior to embarking on any minimally invasive inguinal hernia repair. While complex inguinal hernia repairs have traditionally been relative contraindication for laparoscopic repair due to technical difficulties, the robotic approach may help overcome these challenges. What sets this technique apart is the integration of a structured teaching framework designed to standardise the dissection process. We present the case of an 82-year-old female who underwent rTAPP for bilateral inguinal hernias, classified per the European Hernia Society (EHS) as right (P L2M0F1) and left (P L1M0F1). Following Veress needle insufflation, a 12-mm visiport was inserted in the right pararectal space, with two 8-mm robotic ports placed in linear alignment. Instrumentation included a bipolar grasper, camera, and monopolar scissors. A self-adhesive mesh and barbed sutures were introduced intra-abdominally at the outset. Total operative time was 80 minutes. The urinary catheter was removed post-procedure, and the patient was discharged the same day following an uneventful recovery. In this surgical technique we visually overlay Furtado's concept onto the robotic intraoperative view to create a reproducible anatomical roadmap. By mapping these defined safety and danger zones during the robotic dissection, we translate theoretical anatomy into a practical, stepwise intraoperative guide. This educational overlay aims to enhance reproducibility, anatomical orientation during the surgical learning curve, and potentially reduce complications or recurrence by promoting consistent identification of key landmarks. Whilst further randomised studies comparing robotic and laparoscopic approaches are needed to fully assess the role of robotic approach in surgical treatment of inguinal hernias, this visual framework serves as a training tool for surgeons adapting rTAPP.