The tack technique for robotic ventral mesh rectopexy: An useful, safe and effective trick using the Hugo RAS™ system

We describe our standardized technique for mesh fixation during robotic ventral rectopexy performed with the Hugo RAS™ system. A non-absorbable helical tack device, introduced by the assistant through a robotic trocar, is used to secure the mesh to the anterior surface of the S1 vertebral body. Particular attention is paid to the preservation of critical anatomical structures, including the hypogastric nerves and sacral foramina. This approach, widely adopted in conventional laparoscopy, is reproducible and feasible in the robotic setting with the Hugo RAS™ platform. The system's open modular configuration allows optimized trocar placement and arm angulation, facilitating precise, rapid, and safe tack deployment.

Compared with conventional robotic suturing, this approach provides tactile feedback, ensures precise mesh positioning, and reduces operative time.

To our knowledge, this technique has not been previously reported, and our center is likely among the few worldwide implementing it. This modification offers a safe, effective, and innovative option for mesh fixation during robotic ventral rectopexy.