Robotic Midline Ventral Hernia Repair: Totally Extraperitoneal (TEP)

The overall incidence of incisional hernias is greater than 10%, and recurrence rates following repair range from 5% to 70%, depending on the technique used and the size and complexity of the hernia. The use of mesh has greatly decreased recurrence rates, but its efficacy varies significantly with its anatomic placement. The retromuscular (and for ventral hernias, specifically retrorectus) mesh sublay Rives-Stoppa (RS) technique, with only minor modifications over the 50 years since it was introduced, has now become accepted as the gold standard for surgical management of large ventral hernias. The RS ventral hernia repair (VHR) has been adapted to laparoscopy through the extended totally extraperitoneal (eTEP) approach with at least equivalent long-term outcomes, plus decreases in length of stay and wound complications. Its widespread utilization is hindered by the advanced technical skill required, however, and there is more variability—and debate—in the technical details of laparoscopic eTEP VHR.