Robotic enhanced-view totally extraperitoneal approach for giant incisional hernias: technical aspects and short-term...

Giant incisional hernias (European Hernia Society [EHS] W3, defect width ≥ 10 cm) are traditionally managed via open repair with transversus abdominis release (TAR), which carries substantial wound morbidity. Laparoscopic enhanced-view totally extraperitoneal retrorectus repair (eTEP-RS) reduces wound complications but remains technically demanding in W3 defects. We describe our robotic eTEP-RS with selective TAR technique and report its short-term clinical outcomes. We retrospectively reviewed a prospectively maintained database of 40 consecutive patients who underwent robotic eTEP-RS with selective TAR for EHS W3 incisional hernias at a single high-volume center between December 2024 and December 2025. A standardized lateral three-port technique was utilized in all cases. Technical adaptations for recurrent hernias, "preserve the mesh and sac" techniques for tension-free posterior closure are described. The mean defect width was 12.6 cm (range, 10-18 cm) and the mean mesh coverage was 360.16 cm². TAR was required in 92.5% of cases (42.5% unilateral, 25.0% bilateral, and 25.0% utilizing the preserve-the-sac technique). The mean surgeon console time ranged from 125 to 190 min, and the mean hospital stay was 1.3 days. Intraoperative complications occurred in 7.5% of cases, while postoperative seroma occurred in 10.0%. There were no surgical site infections, conversions to open surgery, or recurrences during a follow-up period of 6-18 months. Robotic eTEP-RS with selective TAR is a safe, reproducible, and effective approach for the repair of giant incisional hernias.