When preoperative CT Scan reveals an inguinal hernia or if I feel one on an exam, I have my patient see a laparoscopic general surgeon so the hernia can be fixed at the same time as the robotic prostatectomy.  When the hernias are diagnosed in the operating room, I call a general surgeon to help me fix the hernia.

In the first 52 robotic prostatectomies I performed, 4 had preoperative hernias and a general surgeon was available.  In another 4 cases (4 of 48 or 9%) I found at least one hernia during the operation.  I called a general surgeon to help fix this.  I usually do this robotically while the general surgeon uses the laparoscopic assistant ports.

The technique is as follows:

1.  The hernia is seen on inspection.  With the transperitoneal approach they are obvious.  The picture below shows the hook cautery inside the hernia defect.

2.  Instead of opening the peritoneal cavity in a limited fashion just lateral to the medial umbilical ligaments, I free up the hernia sac by opening the peritoneum widely over to the anterior superior iliac spine. I then remove the contents of the hernia including fat with the robotic instruments.  This is the first half of the robotic hernia repair video.

3. After the robotic prostatectomy is finished we insert a piece of mesh.  Clips are placed into the mesh to anchor it in place.  We then place the peritoneum that was widely opened over the mesh.  The video shows us covering the mesh with anchoring clips.

We have performed 8 of these repairs now, and have changed the closure of the peritoneum to absorbable suture.

We have not had any complications to date and accept a small chance that there may be a mesh infection, as with any mesh surgery to fix the hernia at the same time.  The same incisions are used as for the robotic prostate and this avoids another operation either before or after surgery to fix the hernia.

Click here for dsl/cable modem feed of a robotic hernia repair.