Transabdominal Preperitoneal (rTAPP) Repair

The repair of ventral incisional hernia is commonly performed in daily surgical practice. For this purpose, the use of the laparoscopic technique has continued to evolve since its inception in 1991. Robotic assisted laparoscopic ventral incisional hernia repair is considered a new approach in the minimally invasive arena. Up to now, there are different planes are described for mesh positioning such as intraperitoneal, preperitoneal and retromuscular. The goal of extraperitoneal mesh positioning is to prevent adhesive complications. Furthermore, placing mesh in the preperitoneal space is more cost effective as compared to a tissue separating mesh which is used in intraperitoneal technique. Because it incorporates directly on fascia, it theoretically decreases the need for sutures or tack fixation. Preperitoneal dissection and mesh fixation in conventional laparoscopic approach technically may become challenging for surgeon. The da Vinci® robot (Intuitive Surgical, Sunnyvale, CA, USA) as an enabling tool, offers numerous advantages overall including 7° of freedom, three-dimensional (3D) imaging, and superior ergonomics that enable precise suturing and dissection at difficult angles. The main focus of this chapter is to explain the technicalities of robotic transabdominal preperitoneal mesh placement for ventral incisional hernias.