V-006 Lumbar hernia: Novel eTEP robotic approach

Abstract Aim Primary lumbar hernias are rare defects on the posterior abdominal wall. The study of these hernias has been described from the anatomical point of view of the anterior pathway (Petit 1783 and Grynfelt 1866). The preperitoneal/retromuscular view has interesting anatomical differences as was described by Moreno-Egea. Open and laparoscopic approach treatment have been described in different articles and lately Kudsi described in his book Robotic Hernia Surgery (2020), an incisional lumbar hernia repair by robotic extended totally extraperitoneal (eTEP) approach placing the trocars in the midline. Kudsi describes an ipsilateral retrorrectal access and a TAR procedure. The aim of this video is to describe a novel eTEP approach in a primary lumbar hernia placing the trocars beyond the semilunaris line avoiding an unnecessary dissection of the retrorrectal space. Material and Methods The case is a 62 years old woman patient with a BMI of 35 who presented a progressive 1-year discomfort bulging in her right lumbar back that turned in pain the last 6 months. MRI was made showing a right lumbar defect with a huge fat tissue content. Once the patient was assessed, an eTEP robotic approach was planned with a Xi Da Vinci robotic platform. The patient was in a hyperextended left-side position. Result The patient was discharged the same day of operation with a mild pain controlled by oral medication. Conclusion The eTEP robotic lumbar hernia approach beyond the semilunaris line is feasible, avoiding a retrorrectal and TAR unnecessary procedure.