Robotic single-port totally extraperitoneal repair and plication for ventral hernia with concomitant rectus...

Midline ventral hernias frequently coexist with rectus diastasis, and failure to address both conditions may compromise functional and cosmetic outcomes. Minimally invasive extraperitoneal techniques preserve the principles of sublay mesh repair while reducing access-related morbidity. The da Vinci Single-Port (SP) robotic platform represents a novel evolution in minimally invasive surgery; however, experience with its use for complex ventral hernia repair with rectus diastasis remains limited.

A 35-year-old woman presented with multiple symptomatic midline ventral hernias and rectus diastasis following a prior cesarean section. Preoperative imaging demonstrated three small fat-containing midline hernias and a 3-4 cm rectus diastasis. The patient underwent robotic SP totally extraperitoneal ventral hernia repair with midline plication and preperitoneal mesh reinforcement through a Pfannenstiel incision. All hernia defects were reduced and incorporated into a single linea alba reconstruction, followed by the placement of sublay mesh. The postoperative course was uneventful, and the patient was discharged on postoperative day 1. At follow-up, she reported complete resolution of symptoms with excellent functional and cosmetic outcomes.

This case highlights the technical feasibility of performing extraperitoneal abdominal wall reconstruction using the robotic SP platform. The approach allows for the correction of rectus diastasis, restoration of the linea alba, and sublay mesh placement through a single concealed incision, while avoiding intraperitoneal mesh placement.

Robotic SP totally extraperitoneal repair of ventral hernia with rectus diastasis is feasible in selected patients and may offer advantages in terms of access-related morbidity and cosmesis. Further studies are required to define patient selection and long-term outcomes.