Standardization and ten essential steps in the lateral robotic extended totally extraperitoneal (eTEP) repair of ventral hernias

ABSTRACT Objectives: described by Dr. Jorge Daes, principles of the enhanced view totally extraperitoneal (eTEP) has been widely used in the armamentarium of ventral hernia repair recently. Robotic assisted eTEP technique feasibility has been proved, however, a complete understanding of retromuscular abdominal wall planes and its landmarks still uncertain in a majority of general surgeons. The aim of this report is to propose a technical standardization and its anatomic concepts in the robotic-assisted eTEP ventral hernia repair. Methods: our group describes 10 key steps in a structured step-by-step approach for a safe and reproducible repair based on well defined anatomic landmarks, identification of zones of dissection and correct restoration of the linea alba. Results: the standardization has been developed 2 years ago and applied to all patients. A robotic-assisted surgery with 3 robotic arms is performed in a lateral docking setup. Feasibility is established and reproducibility is high among general surgeons. Conclusion: we present a standardized side docking robotic assisted eTEP approach for ventral hernia repairs with 10 key steps. We believe understanding the landmarks and a step-by-step guidance based on the concepts of retromuscular abdominal wall anatomy foment a safe learning of minimally invasive restoration of the abdominal wall integrity regarding non-expert surgeons.

【摘要】 目的：由豪赫·达伊斯（Jorge Daes）博士提出的增强视野完全经腹膜外（enhanced view totally extraperitoneal, eTEP）技术，其操作原则近年来已广泛应用于腹疝修补术的临床技术储备中。机器人辅助eTEP技术的可行性已得到证实，但多数普外科医师对腹壁肌后间隙及其解剖标志仍缺乏完整认知。本报告旨在提出机器人辅助eTEP腹疝修补术的技术标准化方案及其解剖学理念。方法：本团队基于明确的解剖标志、解剖分离区域的辨识以及腹白线的正确重建，以结构化分步流程阐述了10项关键步骤，以实现安全且可重复的修补操作。结果：该标准化方案于2年前制定并应用于所有患者。手术采用侧方对接部署模式，配置3根手术机械臂。该方案可行性已得到验证，且普外科医师的操作可重复性较高。结论：本研究提出了一种包含10项关键步骤的侧方对接机器人辅助eTEP腹疝修补术方案。我们认为，掌握解剖标志并基于腹壁肌后间隙解剖学理念的分步操作指导，可助力非资深外科医师安全学习微创重建腹壁完整性的技术。