Image Inversion during Xi Robotic ventral hernia repair: making it even more effective

ABSTRACT Introduction: currently, there are several clinical applications for robot-assisted surgery and in the hernia scenario, robot-assisted surgery seems to have the ability to overcome laparoscopic ventral hernias repairs limitations, facilitating dissection, defect closure, and mesh positioning. Exponentially grown in numbers of robotic approaches have been seen and even more complex and initially not suitable cases have recently become eligible for it. An appropriate tension-free reestablishment of the linea alba is still a major concern in hernia surgery and even with the robotic platform, dissecting and suturing in anterior abdominal wall may be challenging. This article reports a technical image artifice during a da vinci Xi-platform robotic ventral hernia repair allowing the surgeon to establish a more familiar and ergonomic manner to perform dissection and suturing in anterior abdominal wall. Technical Report: a step by step guided technique of image inversion artifice is described using detailed commands and figures to assure optimal surgical field and ergonomics whenever acting in robotic ventral hernias repair with the da Vinci Xi-platform. Our group brief experience is also reported, showing an easy and reproducible feature among surgeons with safe outcomes. Conclusion: we consider that image inversion artifice is a simple and reproducible feature in robotic ventral hernia repair. Through a step-by-step guide, this report enables the creation of an artifice providing a comfortable operative field and allowing the surgeon to achieve its best proficiency in hernia surgery.

摘要
引言：当前，机器人辅助手术（robot-assisted surgery）已拥有多项临床应用场景；在疝外科领域，机器人辅助手术有望克服腹腔镜腹侧疝修补术的局限性，简化解剖分离、缺损闭合以及补片定位操作。机器人手术术式的数量呈指数级增长，即便针对此前初始评估不适合手术的复杂病例，如今也可纳入机器人手术的适应证范围。精准无张力重建腹白线（linea alba）仍是疝外科的核心难题之一，即便借助机器人手术平台，在前腹壁开展解剖分离与缝合操作仍颇具挑战。本文报道了一项基于达芬奇Xi（da Vinci Xi）手术平台的腹侧疝机器人修补术中的图像反转操作技巧，可帮助术者采用更为熟悉且符合人体工程学的方式完成前腹壁的解剖分离与缝合操作。
技术报告：本文详细阐述了图像反转技巧的分步操作指南，辅以具体操作指令与示意图，确保在使用达芬奇Xi（da Vinci Xi）手术平台开展腹侧疝机器人修补术时，能够获得最佳手术视野与符合人体工程学的操作姿态。本文同时汇报了本团队的初步应用经验，结果显示该技巧操作简便、可重复性强，且临床安全性良好，可供外科医师推广应用。
结论：我们认为图像反转技巧在腹侧疝机器人修补术中具备简便易行、可复制的优势。通过本分步操作指南，本报告提出的这一技巧可打造舒适的手术操作环境，助力术者充分发挥疝外科手术的最佳操作水平。